Healthcare Provider Details

I. General information

NPI: 1508776386
Provider Name (Legal Business Name): ANTHONY COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 MARTIN LUTHER KING BLVD SUITE 212
N. LAS VEGAS NV
89032
US

IV. Provider business mailing address

4429 WESTMERE AVE
N LAS VEGAS NV
89084-4913
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-0235
  • Fax: 702-992-3505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5713-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: