1285732032 NPI number — JOHN (JACK) JOSEPH COLLINS LCMHC

Table of content: JOHN (JACK) JOSEPH COLLINS LCMHC (NPI 1285732032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285732032 NPI number — JOHN (JACK) JOSEPH COLLINS LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
JOHN (JACK)
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
JACK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285732032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
481 MORRILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03249-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-393-8876
Provider Business Mailing Address Fax Number:
603-528-6401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 LAFAYETTE RD
Provider Second Line Business Practice Location Address:
#206
Provider Business Practice Location Address City Name:
NORTH HAMPTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03862-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-964-1700
Provider Business Practice Location Address Fax Number:
603-964-1701
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  583 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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