| Doctor Name: | MR. ANDRWEW JOHN COLLURA |
| NPI Number: | 1578839478 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SAC-IT |
| License Number: | 16128-130 |
| Business Practice Address: | 9415 W Forest Home Ave Ste 108 Hales Corners, WI - 531301680 |
| Business Phone Number: | 4144274884 |
| Business Fax Number: | 4144274889 |
| Mailing Address: | 9415 W Forest Home Ave Ste 108, HALES CORNERS |
| State: | WI |
| Postal Code: | 531301680 |
| Phone Number: | 4144274884 |
| Fax Number: | 4144274889 |
| NPI Enumeration Date: | 03/26/2012 |
| NPI Last Update Date: | 03/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 16128-130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |