MEDICARE: MITCHELL COLLINS

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	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100312	OTHER	CA	STAFF NUMBER

General Provider Information

NPI Number	:	1174666291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL COLLINS

Provider Business Mailing Address
First Line	:	3636 N 1ST ST STE 162
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6869
Country	:	US
Telephone Number	:	559-476-2166
Fax Number	:	844-563-6035

Provider Business Practice Location Address
First Line	:	3636 N 1ST ST
Second Line	:	SUITE 162
City	:	FRESNO
State	:	CA
Zip	:	93726-6800
Country	:	US
Telephone Number	:	559-210-2773
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	10/02/2020

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Directions to “ MITCHELL COLLINS ” Practice Location

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