Individual
DR. COLETTE BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
4521 N MOZART ST, CHICAGO, IL 60625-3816
(312) 203-2158
(312) 203-2158
Mailing address
4521 N MOZART ST, CHICAGO, IL 60625-3816
(312) 203-2158
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180009264
IL
101YP2500X
Professional Counselor
178003235
IL
Other
Enumeration date
11/03/2006
Last updated
09/08/2016
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