Healthcare Provider Details

I. General information

NPI: 1831493873
Provider Name (Legal Business Name): NATALIE GENE COLLISON MA. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 CONTENTA RDG
SANTA FE NM
87507-6604
US

IV. Provider business mailing address

4710 CONTENTA RDG
SANTA FE NM
87507-6604
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-6571
  • Fax:
Mailing address:
  • Phone: 505-438-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT-0136101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: