MEDICARE: TERESE COLASUONNO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401008782	MI

General Provider Information

NPI Number	:	1629520432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESE COLASUONNO LPC

Provider Business Mailing Address
First Line	:	1460 WALTON BLVD STE 50
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1729
Country	:	US
Telephone Number	:	248-563-0154
Fax Number	:	866-745-6418

Provider Business Practice Location Address
First Line	:	1460 WALTON BLVD STE 50
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1729
Country	:	US
Telephone Number	:	248-563-0154
Fax Number	:	866-745-6418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	08/25/2025

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