MEDICARE: RICHARD WILLIAM COLLINS, PSYD, PLLC

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	103TC0700X	Clinical Psychologist	37807	TX
2	103TP0814X	Psychoanalysis Psychologist	37807	TX
3	103T00000X	Psychologist	37807	TX

General Provider Information

NPI Number	:	1437639523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD WILLIAM COLLINS, PSYD, PLLC

Provider Business Mailing Address
First Line	:	6125 LUTHER LN # 328
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4237 BRYN MAWR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6739
Country	:	US
Telephone Number	:	214-726-6095
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	RICHARD WILLIAM COLLINS
Credential	:	PSYD
Telephone Number	:	214-726-6095

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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