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NPI Code Detail

MEDICARE: COLLINS CLINICAL GROUP, P.C.

MEDICARE: COLLINS CLINICAL GROUP, P.C.
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
1101YP2500XProfessional Counselor180.008547IL

General Provider Information

NPI Number : 1649608191
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLINS CLINICAL GROUP, P.C.
Provider Business Mailing Address
First Line : 4433 N RAVENSWOOD AVE STE 210
Second Line :
City : CHICAGO
State : IL
Zip : 60640-7755
Country : US
Telephone Number : 312-399-9601
Fax Number : 773-944-1057
Provider Business Practice Location Address
First Line : 4433 N RAVENSWOOD AVE STE 210
Second Line :
City : CHICAGO
State : IL
Zip : 60640-7755
Country : US
Telephone Number : 312-399-9601
Fax Number : 773-944-1057
Authorized Official
Title or Position : OWNER
Name : MR. CALEB D COLLINS
Credential : LCPC
Telephone Number : 312-399-9601
Provider Enumeration Date : 10/21/2013
Last Update Date : 02/18/2019

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