Individual
MS. COLLEEN M LAREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
604 N 2ND ST, EFFINGHAM, IL 62401-3324
(217) 685-3739
Mailing address
604 N 2ND ST, EFFINGHAM, IL 62401-3324
(217) 685-3739
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178008774
IL
103TB0200X
Cognitive & Behavioral Psychologist
6301013487
MI
103TC1900X
Counseling Psychologist
6301013487
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260D16159
BCBS GROUP NUMBER
MI
01
—
38-2831313
AGENCY TAX NUMBER
MI
Enumeration date
02/07/2007
Last updated
01/07/2019
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