Healthcare Provider Details

I. General information

NPI: 1104789320
Provider Name (Legal Business Name): ALYSSA COLLINS MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 PINE GOLD HILL ST
BOULDER CO
80302-8755
US

IV. Provider business mailing address

570 PINE GOLD HILL ST
BOULDER CO
80302-8755
US

V. Phone/Fax

Practice location:
  • Phone: 646-276-3477
  • Fax:
Mailing address:
  • Phone: 646-276-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023453
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: