Provider Demographics
NPI:1962915579
Name:COLLABORATIVE COUNSELING GROUP
Entity type:Organization
Organization Name:COLLABORATIVE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-234-0267
Mailing Address - Street 1:202 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1441
Mailing Address - Country:US
Mailing Address - Phone:270-312-2860
Mailing Address - Fax:
Practice Address - Street 1:208 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1464
Practice Address - Country:US
Practice Address - Phone:270-312-2860
Practice Address - Fax:270-312-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health