1619069747 NPI number — MR. JAMES P COLLINS LCMHC

Table of content: MR. JAMES P COLLINS LCMHC (NPI 1619069747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619069747 NPI number — MR. JAMES P COLLINS LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
JAMES
Provider Middle Name:
P
Provider Name Prefix Text:
MR.
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:
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:
1619069747
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:
121 IROQUOIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESSEX JUNCTION
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05452-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-879-3372
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 W TWIN OAKS TER
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SOUTH BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05403-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-3333
Provider Business Practice Location Address Fax Number:
802-847-1424
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
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Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  068-0000056 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007090 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".