Healthcare Provider Details

I. General information

NPI: 1962243097
Provider Name (Legal Business Name): AMBER MARIE COLLINS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 MOROCCO STREET SUITE 202
SAN ANTONIO TX
78216
US

IV. Provider business mailing address

10127 MOROCCO STREET SUITE 202
SAN ANTONIO TX
78216
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-5351
  • Fax: 210-800-9922
Mailing address:
  • Phone: 210-838-5351
  • Fax: 210-800-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number71032
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: