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General NPI Number Information
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NPI Number | 1881546356
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Entity Type | Organization
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Legal Business Name | COLLECTIVE CARE OUTPATIENT SERVICES, LLC
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 5701 KENTUCKY AVE N STE 100
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City | CRYSTAL
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State | MN
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Zip | 55428-3370
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Country | US
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Telephone | 612-386-7144
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Fax | 651-286-0901
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Provider Business Mailing Address
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Address Line | 5701 KENTUCKY AVE N STE 100
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City | CRYSTAL
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State | MN
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Zip | 55428-3370
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Country | US
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Telephone | 612-386-7144
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Fax | 651-286-0901
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Authorized Official
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Title or Position | TREATMENT DIRECTOR
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Name | DR. ABYAN BASHIR
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Credential | MSW, LICSW, PSYD
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Telephone | 612-968-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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