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General NPI Number Information
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NPI Number | 1639116536
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Entity Type | Individual
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Provider Name | JAN MARIE COLLIER L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 222 GOVERNMENT AVE
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City | NICEVILLE
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State | FL
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Zip | 32578-1868
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Country | US
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Telephone | 850-678-1846
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Fax |
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Provider Business Mailing Address
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Address Line | 18 GUM ST
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City | FREEPORT
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State | FL
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Zip | 32439-6708
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Country | US
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Telephone | 850-897-7248
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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 | MH3495
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License Number State | FL
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