Delores Ann O'Dell McCollum, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071005753 Issued in IL

Practice address

2100 18TH Avenue, Ste 6
Rock Island, IL 61201

Phone

(309) 788-0730

Fax

(309) 788-0733

NPI assigned

Oct 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Lori Odell McCollum Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vera French Community Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bettendorf, IA
  • NPI 1568239978
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463011200000",
    "number": "1922181122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 18TH AVENUE, STE 6",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "61201",
            "telephone_number": "309-788-0730",
            "fax_number": "309-788-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 18TH AVENUE, STE 6",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "61201",
            "telephone_number": "309-788-0730",
            "fax_number": "309-788-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DELL MCCOLLUM",
        "first_name": "DELORES",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2016-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071005753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00855",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORI",
            "last_name": "ODELL MCCOLLUM",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jamie Lynne Nowlin, BA
• Mary Francis M Nuguid, MD
• Chukwuemeka Nzewi, M.D
• Erika Lynn O'Brien, DNP, AGACNP-BC, CCRN
• Gwen O'Connell
• James O'Grady, PHARMD
• Raymond Eugene O'Neill
• Leslie W. O'Ryan, EDD
• Fredrick Oakley, M.D., PH. D.
• Occupational Health Centers of Illinois PC

• Psychologist in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.