MEDICARE: LINDA L 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	19044	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7030911	OTHER	TX	AETNA
2	COLLILIN	OTHER	TX	CORPHEALTH
3	258700	OTHER	TX	COMPSYCH

General Provider Information

NPI Number	:	1720281173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA L COLLINS LPC

Provider Business Mailing Address
First Line	:	6017 REEF POINT LN
Second Line	:	SUITE 115
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7004
Country	:	US
Telephone Number	:	817-480-7544
Fax Number	:	817-237-7351

Provider Business Practice Location Address
First Line	:	6017 REEF POINT LN
Second Line	:	SUITE 115
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7004
Country	:	US
Telephone Number	:	817-480-7544
Fax Number	:	817-237-7351

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/08/2007

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