Provider Demographics
NPI:1023364346
Name:COLLINS, LAUREN KRISTIN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTIN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 17TH ST
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1527
Mailing Address - Country:US
Mailing Address - Phone:510-628-9070
Mailing Address - Fax:
Practice Address - Street 1:519 17TH ST
Practice Address - Street 2:SUITE # 210
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1527
Practice Address - Country:US
Practice Address - Phone:510-628-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic