MEDICARE: AMANDA COLLINS

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	4938C	NV

General Provider Information

NPI Number	:	1699932236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COLLINS

Provider Business Mailing Address
First Line	:	7981 IMPERIAL TREASURE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6239
Country	:	US
Telephone Number	:	702-758-9755
Fax Number	:

Provider Business Practice Location Address
First Line	:	7981 IMPERIAL TREASURE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6239
Country	:	US
Telephone Number	:	702-758-9755
Fax Number	:

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	11/02/2015

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Directions to “ AMANDA COLLINS ” Practice Location

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