1609275379 NPI number — MELISSA S. COLLINS

Table of content: (NPI 1609275379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609275379 NPI number — MELISSA S. COLLINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELISSA S. COLLINS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MELISSA S. COLLINS COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609275379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 N 1ST ST STE 4A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59840-2556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-531-7164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 N 1ST ST
Provider Second Line Business Practice Location Address:
4A
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59840-2599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-531-7164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
THERAPIST/COUNSELOR
Authorized Official Telephone Number:
406-531-7164

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1169 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 983 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)