MEDICARE: MOLLY C 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	1041C0700X	Clinical Social Worker	L6840	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	L4710	OTHER	ID	BCI-MENTAL HEALTH

General Provider Information

NPI Number	:	1447387964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY C COLLINS LCSW

Provider Business Mailing Address
First Line	:	272 NW MEDICAL LOOP STE E
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5545
Country	:	US
Telephone Number	:	541-900-4285
Fax Number	:	888-810-2993

Provider Business Practice Location Address
First Line	:	272 NW MEDICAL LOOP STE E
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5545
Country	:	US
Telephone Number	:	541-900-4285
Fax Number	:	888-810-2993

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	01/08/2024

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Directions to “ MOLLY C COLLINS LCSW” Practice Location

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