Healthcare Provider Details

I. General information

NPI: 1154138857
Provider Name (Legal Business Name): COLLABCORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 FLOSSMOOR RD UNIT 2E
FLOSSMOOR IL
60422-1100
US

IV. Provider business mailing address

2713 FLOSSMOOR RD UNIT 2E
FLOSSMOOR IL
60422-1100
US

V. Phone/Fax

Practice location:
  • Phone: 708-719-1970
  • Fax: 708-726-5249
Mailing address:
  • Phone: 313-729-9376
  • Fax: 708-726-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLEY MCKEEVER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY D
Phone: 313-729-9376