Healthcare Provider Details

I. General information

NPI: 1629983911
Provider Name (Legal Business Name): MAYA COLLINS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 TOWER AVE
SAINT BERNARD OH
45217-1724
US

IV. Provider business mailing address

400 N ERIE HWY STE A
HAMILTON OH
45011-4264
US

V. Phone/Fax

Practice location:
  • Phone: 513-482-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: