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Organization
COLIBERATE USA
Active
Organization
COLIBERATE USA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOEL C GREEN LSW (AUTHORIZED REPRESENTATIVE)
(312) 818-0497
Entity
Organization
Contact information
Practice address
200 W MADISON ST, CHICAGO, IL 60606-3414
(312) 210-0965
Mailing address
9449 S KEDZIE AVE # 331, EVERGREEN PARK, IL 60805-2325
(312) 210-0965
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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