Healthcare Provider Details

I. General information

NPI: 1922825272
Provider Name (Legal Business Name): FLETCHER LEE COLLINS JR. PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 SW GEMINI DR
BEAVERTON OR
97008-7105
US

IV. Provider business mailing address

43544 CEDARHURST DR
VAN BUREN TOWNSHIP MI
48111-4572
US

V. Phone/Fax

Practice location:
  • Phone: 971-812-1770
  • Fax:
Mailing address:
  • Phone: 313-639-7001
  • Fax: 971-746-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704346698
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10054608
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: