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NPI Code Detail

MEDICARE: COLIN ALPHONSO MS

MEDICARE:   COLIN  ALPHONSO  MS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor17139TX
2101YP2500XProfessional Counselor94862TX

General Provider Information

NPI Number : 1558187070
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLIN ALPHONSO MS
Provider Business Mailing Address
First Line : 4124 CHIEF DR
Second Line :
City : CARROLLTON
State : TX
Zip : 75007-1474
Country : US
Telephone Number : 972-946-2002
Fax Number :
Provider Business Practice Location Address
First Line : 4040 N CENTRAL EXPY
Second Line :
City : DALLAS
State : TX
Zip : 75204-3158
Country : US
Telephone Number : 972-557-1617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2024
Last Update Date : 11/30/2024

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