Healthcare Provider Details

I. General information

NPI: 1588733513
Provider Name (Legal Business Name): JAMES CHRISTOPHER COLLINS SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SUTTER PL
CLOVIS NM
88101-4611
US

IV. Provider business mailing address

1115 GIDDING ST
CLOVIS NM
88101-5957
US

V. Phone/Fax

Practice location:
  • Phone: 505-769-4490
  • Fax: 505-935-0011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number310883
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: