1568730521 NPI number — DAWN R COLLINS MA, LLPC

Table of content: DAWN R COLLINS MA, LLPC (NPI 1568730521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568730521 NPI number — DAWN R COLLINS MA, LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
DAWN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1568730521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6549 TOWN CENTER DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346-4824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-620-6400
Provider Business Mailing Address Fax Number:
248-620-6405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5775 W MAPLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-4447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-855-1540
Provider Business Practice Location Address Fax Number:
248-855-2481
Provider Enumeration Date:
12/06/2011

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: 101YP2500X , with the licence number:  6401012743 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019027 . This is a "MIDWEST MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910932 . This is a "BCCHRY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: XX19153 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000260F7 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910932 . This is a "BCFED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910932 . This is a "BCBS MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910932 . This is a "BCTR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910932 . This is a "BCMI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910932 . This is a "BCOOS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com