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NPI Code Detail

MEDICARE: COLLINS PSYCHOLOGICAL THERAPY & CONSULTING INC.

MEDICARE: COLLINS PSYCHOLOGICAL THERAPY & CONSULTING INC.
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
1103T00000XPsychologistPSY 16251CA

General Provider Information

NPI Number : 1215175179
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLINS PSYCHOLOGICAL THERAPY & CONSULTING INC.
Provider Business Mailing Address
First Line : 3707 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4111
Country : US
Telephone Number : 619-296-7757
Fax Number :
Provider Business Practice Location Address
First Line : 3707 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4111
Country : US
Telephone Number : 619-296-7757
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. LINDA LOUISE COLLINS
Credential : PH.D.
Telephone Number : 619-296-7757
Provider Enumeration Date : 01/30/2009
Last Update Date : 01/30/2009

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