Healthcare Provider Details

I. General information

NPI: 1013830157
Provider Name (Legal Business Name): EMERY COLLINS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W CHANDLER BLVD STE 250
CHANDLER AZ
85224-6162
US

IV. Provider business mailing address

11334 E ULYSSES AVE
MESA AZ
85212-6556
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-2774
  • Fax:
Mailing address:
  • Phone: 623-243-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: