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General NPI Number Information
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NPI Number | 1770245680
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Entity Type | Individual
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Provider Name | JOHN COLLIS LPC, LCDC
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Gender | Male
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 112 CHURCH STREET
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City | HUNT
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State | TX
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Zip | 78024
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Country | US
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Telephone | 830-928-2541
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | HUNT
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State | TX
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Zip | 78024-0124
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Country | US
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Telephone | 830-238-4865
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 83197
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License Number State | TX
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