Healthcare Provider Details

I. General information

NPI: 1184106692
Provider Name (Legal Business Name): AUDREY B COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3856 S JERICHO CT
AURORA CO
80013-3871
US

IV. Provider business mailing address

3856 S JERICHO CT
AURORA CO
80013-3871
US

V. Phone/Fax

Practice location:
  • Phone: 303-946-5221
  • Fax: 888-600-9221
Mailing address:
  • Phone: 303-946-5221
  • Fax: 888-600-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNLC.0012885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: