MEDICARE: JULIE ANNE COLLINS LMHC

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	39000263A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000363881	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1962492280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANNE COLLINS LMHC

Provider Business Mailing Address
First Line	:	5201 E US HIGHWAY 36
Second Line	:	SUITE 503
City	:	AVON
State	:	IN
Zip	:	46123-7837
Country	:	US
Telephone Number	:	317-745-9555
Fax Number	:	317-745-9565

Provider Business Practice Location Address
First Line	:	540 TRACY RD
Second Line	:	SUITE C
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-9699
Country	:	US
Telephone Number	:	765-482-7421
Fax Number	:	765-482-7462

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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