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General NPI Number Information
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NPI Number | 1194653899
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Entity Type | Individual
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Provider Name | JASON D COLLINS RN, PMHNP
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Gender | Male
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 3815 PELHAM ST STE 13
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City | DEARBORN
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State | MI
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Zip | 48124-3852
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Country | US
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Telephone | 313-722-4683
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Fax |
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Provider Business Mailing Address
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Address Line | 20401 FOXBORO ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-7919
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Country | US
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Telephone | 313-690-4145
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704327008
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License Number State | MI
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