MEDICARE: AINSLEY GRACE COLLINS LPC

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	6964	NC
2	101YP2500X	Professional Counselor	10715	AZ

General Provider Information

NPI Number	:	1356584684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AINSLEY GRACE COLLINS LPC

Provider Business Mailing Address
First Line	:	50417 N 26TH DR
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-9679
Country	:	US
Telephone Number	:	623-465-4489
Fax Number	:

Provider Business Practice Location Address
First Line	:	50417 N 26TH DR
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-9679
Country	:	US
Telephone Number	:	623-465-4489
Fax Number	:

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

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/16/2009

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Directions to “ AINSLEY GRACE COLLINS LPC” Practice Location

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