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General NPI Number Information
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NPI Number | 1104228642
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Entity Type | Individual
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Provider Name | TIMOTHY R COLLINS LISW-S
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Gender | Male
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 3929 ROCKY RIVER DR
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City | CLEVELAND
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State | OH
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Zip | 44111-4153
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Country | US
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Telephone | 216-252-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 27391 DETROIT RD APT C34
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City | WESTLAKE
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State | OH
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Zip | 44145-2278
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Country | US
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Telephone | 216-647-1941
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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 | I.2103188
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S 1450685
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2103188
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License Number State | OH
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