MEDICARE: JENNIFER DENISE COLLINS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT102155	CA

General Provider Information

NPI Number	:	1013326669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DENISE COLLINS LMFT

Provider Business Mailing Address
First Line	:	7403 WALPOLE AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-4939
Country	:	US
Telephone Number	:	760-514-1864
Fax Number	:

Provider Business Practice Location Address
First Line	:	7403 WALPOLE AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-4939
Country	:	US
Telephone Number	:	760-514-1864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	05/24/2021

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