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General NPI Number Information
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NPI Number | 1003171711
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Entity Type | Individual
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Provider Name | KELLY MICHELLE COLLINS PH. D., LPC NCC RPT
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Gender | Female
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 15803 NE 23RD ST # B
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City | CHOCTAW
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State | OK
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Zip | 73020-8428
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Country | US
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Telephone | 405-639-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 623 N CAROLYN DR
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City | CHOCTAW
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State | OK
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Zip | 73020-7481
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Country | US
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Telephone | 405-464-8679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2381
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License Number State | OK
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