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NPI Code Detail

MEDICARE: DEAVON LYNETTE COLLINS LPC-IT

MEDICARE: DEAVON LYNETTE COLLINS LPC-IT
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 Counselor4259WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14259OTHERWILPC-IT

General Provider Information

NPI Number : 1588125546
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAVON LYNETTE COLLINS LPC-IT
Provider Business Mailing Address
First Line : 4906 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-2325
Country : US
Telephone Number : 414-270-4670
Fax Number :
Provider Business Practice Location Address
First Line : 4906 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-2325
Country : US
Telephone Number : 414-270-4670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2019
Last Update Date : 03/30/2019

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Directions to “ DEAVON LYNETTE COLLINS LPC-IT” Practice Location

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