MEDICARE: GLORIA COLLEEN COLLINS EDD, LPC, NCC, BCTMH

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	101YP2500X	Professional Counselor	1823	MS
2	101YM0800X	Mental Health Counselor	1823	MS

General Provider Information

NPI Number	:	1235599135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA COLLEEN COLLINS EDD, LPC, NCC, BCTMH

Provider Business Mailing Address
First Line	:	10721 EAGLE NEST RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-9711
Country	:	US
Telephone Number	:	225-936-2959
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3826
Country	:	US
Telephone Number	:	228-369-8379
Fax Number	:

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

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	04/13/2019

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