MEDICARE: ERICA COLLINS LCSW

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	2021009493	MO

General Provider Information

NPI Number	:	1275006793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA COLLINS LCSW

Provider Business Mailing Address
First Line	:	825 S BUSINESS HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 N BISMARK ST STE A
Second Line	:
City	:	CONCORDIA
State	:	MO
Zip	:	64020-8101
Country	:	US
Telephone Number	:	660-463-0234
Fax Number	:

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

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	05/26/2021

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