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General NPI Number Information
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NPI Number | 1093438798
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Entity Type | Individual
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Provider Name | BRENDON MICHAEL COLLINS M.ED, PLPC
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Gender | Male
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 320 GRAVOIS RD STE 230
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City | FENTON
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State | MO
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Zip | 63026-4122
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Country | US
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Telephone | 636-600-0446
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Fax |
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Provider Business Mailing Address
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Address Line | 913 NANA LN
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City | DES PERES
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State | MO
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Zip | 63131-4627
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Country | US
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Telephone | 314-303-8388
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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