Provider Demographics
NPI:1154138857
Name:COLLABCORE
Entity type:Organization
Organization Name:COLLABCORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:313-729-9376
Mailing Address - Street 1:2713 FLOSSMOOR RD UNIT 2E
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1100
Mailing Address - Country:US
Mailing Address - Phone:313-729-9376
Mailing Address - Fax:708-726-5249
Practice Address - Street 1:2713 FLOSSMOOR RD UNIT 2E
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1100
Practice Address - Country:US
Practice Address - Phone:708-719-1970
Practice Address - Fax:708-726-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)