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General NPI Number Information
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NPI Number | 1952664203
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Entity Type | Organization
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Legal Business Name | COLLINS SERVICES & MANAGEMENT LLC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 107 S GAINES ST STE 105
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City | ENNIS
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State | TX
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Zip | 75119-4612
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Country | US
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Telephone | 469-337-7152
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Fax | 972-875-3808
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Provider Business Mailing Address
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Address Line | PO BOX 263
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City | ENNIS
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State | TX
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Zip | 75120-0263
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Country | US
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Telephone | 469-337-7152
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Fax | 972-875-3808
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DANA R COLLINS
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Credential | MA, LPC
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Telephone | 469-337-7152
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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 | 18276
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License Number State | TX
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