Healthcare Provider Details

I. General information

NPI: 1831233113
Provider Name (Legal Business Name): SARAH FAITH COLLINS L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11224 86TH AVE N
MAPLE GROVE MN
55369-4510
US

IV. Provider business mailing address

410 LANCASTER LN N
CHAMPLIN MN
55316-4002
US

V. Phone/Fax

Practice location:
  • Phone: 763-647-8798
  • Fax:
Mailing address:
  • Phone: 651-353-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP5074
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: