MEDICARE: MIRIAM B COLLINS PSYD MFT

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	103T00000X	Psychologist	6940	CA

General Provider Information

NPI Number	:	1154691798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM B COLLINS PSYD MFT

Provider Business Mailing Address
First Line	:	5812 ALCOVE AVE
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1002
Country	:	US
Telephone Number	:	818-763-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5812 ALCOVE AVE
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1002
Country	:	US
Telephone Number	:	818-763-8222
Fax Number	:

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	04/19/2026

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