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NPI Code Detail

MEDICARE: MR. RUSSELL AMBROSE COLLINS LMFT

MEDICARE: MR. RUSSELL AMBROSE 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
1106H00000XMarriage & Family Therapist40797CA

General Provider Information

NPI Number : 1033105911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RUSSELL AMBROSE COLLINS LMFT
Provider Business Mailing Address
First Line : 1187 COAST VILLAGE RD
Second Line : 1-361
City : SANTA BARBARA
State : CA
Zip : 93108-2737
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1530 SAN LEANDRO LN
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93108-2636
Country : US
Telephone Number : 805-969-6370
Fax Number : 805-456-0632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 07/08/2007

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