MEDICARE: MS. MARY C COLLINS MSN, LMFT

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	101YM0800X	Mental Health Counselor	033	CO

General Provider Information

NPI Number	:	1306859889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY C COLLINS MSN, LMFT

Provider Business Mailing Address
First Line	:	1800 S SHERMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3117
Country	:	US
Telephone Number	:	303-778-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 S SHERMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3117
Country	:	US
Telephone Number	:	303-778-0557
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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