MEDICARE: JOHN (JACK) JOSEPH COLLINS LCMHC

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	101YM0800X	Mental Health Counselor	583	NH

General Provider Information

NPI Number	:	1285732032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN (JACK) JOSEPH COLLINS LCMHC

Provider Business Mailing Address
First Line	:	481 MORRILL ST
Second Line	:
City	:	GILFORD
State	:	NH
Zip	:	03249-6501
Country	:	US
Telephone Number	:	603-393-8876
Fax Number	:	603-528-6401

Provider Business Practice Location Address
First Line	:	216 LAFAYETTE RD
Second Line	:	#206
City	:	NORTH HAMPTON
State	:	NH
Zip	:	03862-2445
Country	:	US
Telephone Number	:	603-964-1700
Fax Number	:	603-964-1701

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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