=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215175179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLLINS PSYCHOLOGICAL THERAPY & CONSULTING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2009
-----------------------------------------------------
Last Update Date | 01/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3707 3RD AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-296-7757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3707 3RD AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-296-7757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LINDA LOUISE COLLINS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 619-296-7757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY 16251
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------