MEDICARE: JAZMINE LASHAY COLLINS LPC05750

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	101YM0800X	Mental Health Counselor	LPC05750	AL

General Provider Information

NPI Number	:	1780303123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE LASHAY COLLINS LPC05750

Provider Business Mailing Address
First Line	:	3360 STONEY BROOK TRL APT 111
Second Line	:
City	:	FULTONDALE
State	:	AL
Zip	:	35068-2244
Country	:	US
Telephone Number	:	205-616-5881
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 MEDICAL PARK DR E
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3400
Country	:	US
Telephone Number	:	205-616-5881
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	01/20/2026

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