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NPI Code Detail

MEDICARE: DR. JESSE DANIEL COLLINS PHD, LMHC

MEDICARE: DR. JESSE DANIEL COLLINS PHD, LMHC
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
1101YM0800XMental Health CounselorMH10669FL

General Provider Information

NPI Number : 1003312703
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE DANIEL COLLINS PHD, LMHC
Provider Business Mailing Address
First Line : 5154 ROYAL CYPRESS CIR
Second Line :
City : TAMPA
State : FL
Zip : 33647-5052
Country : US
Telephone Number : 813-376-6234
Fax Number :
Provider Business Practice Location Address
First Line : 15310 AMBERLY DR STE 250
Second Line :
City : TAMPA
State : FL
Zip : 33647-1642
Country : US
Telephone Number : 813-376-6234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 04/02/2018

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