Healthcare Provider Details

I. General information

NPI: 1194653899
Provider Name (Legal Business Name): JASON D COLLINS RN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 PELHAM ST STE 13
DEARBORN MI
48124-3852
US

IV. Provider business mailing address

20401 FOXBORO ST
RIVERVIEW MI
48193-7919
US

V. Phone/Fax

Practice location:
  • Phone: 313-722-4683
  • Fax:
Mailing address:
  • Phone: 313-690-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704327008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: