=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487141115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD ALBERT COLLINS MA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2018
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3045 GRANGE HALL RD STE 300
-----------------------------------------------------
City | HOLLY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48442-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-382-7136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2447 HOUSER RD
-----------------------------------------------------
City | HOLLY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48442-8371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-881-3181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401008410
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 6401008410
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------