Provider Demographics
NPI:1033564398
Name:COLLINS, CHRISTIE GAIL (LPC, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:GAIL
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC, BCBA
Other - Prefix:MRS
Other - First Name:CHRISTIE
Other - Middle Name:GAIL
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 S CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4101
Mailing Address - Country:US
Mailing Address - Phone:719-473-9200
Mailing Address - Fax:
Practice Address - Street 1:805 S CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4101
Practice Address - Country:US
Practice Address - Phone:719-473-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-22433103K00000X
COLPC.0013986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00684210Medicaid