Individual
DR. TERRENCE JAMES KOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1740 RIDGE AVE, 200 C, EVANSTON, IL 60201-5918
(847) 475-5551
Mailing address
2317 HARTREY AVE, EVANSTON, IL 60201-2552
(847) 864-2317
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071002716
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01672636
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
08/23/2005
Last updated
10/07/2011
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