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General NPI Number Information
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NPI Number | 1255902151
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Entity Type | Individual
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Provider Name | MAGDA GISELLE COLLAZO CT
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Gender | Female
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 5209 DETROIT AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-2224
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Country | US
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Telephone | 216-815-1019
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 VANDALIA AVE
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City | CLEVELAND
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State | OH
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Zip | 44144-3945
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Country | US
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Telephone | 216-507-8045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.2204434
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License Number State | OH
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