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General NPI Number Information
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NPI Number | 1649540352
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Entity Type | Individual
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Provider Name | ELAINE R COLLINS PH.D., LMFC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 17817 SANTIAGO BLVD VILLA PARK MEDICAL
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City | VILLA PARK
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State | CA
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Zip | 92861
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Country | US
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Telephone | 714-350-8634
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Fax | 714-733-5699
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Provider Business Mailing Address
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Address Line | 18340 YORBA LINDA BLVD SUITE 107-280
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City | YORBA LINDA
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State | CA
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Zip | 92886-4058
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Country | US
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Telephone | 714-350-8634
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Fax | 714-733-5699
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 48471
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License Number State | CA
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