Healthcare Provider Details

I. General information

NPI: 1093436057
Provider Name (Legal Business Name): DONNA LARAE COLLINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 TAFT BLVD STE 2
WICHITA FALLS TX
76308-4800
US

IV. Provider business mailing address

4722 TAFT BLVD STE 2
WICHITA FALLS TX
76308-4800
US

V. Phone/Fax

Practice location:
  • Phone: 940-691-1899
  • Fax: 940-691-3423
Mailing address:
  • Phone: 940-691-1899
  • Fax: 940-691-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number75118
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: