Provider Demographics
NPI:1073952164
Name:COLLINS, CASSAUNDRA A (LMSW)
Entity Type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:A
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1102 EASTLAND DR N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8443
Mailing Address - Country:US
Mailing Address - Phone:208-734-1281
Mailing Address - Fax:208-734-1282
Practice Address - Street 1:1102 EASTLAND DR N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8443
Practice Address - Country:US
Practice Address - Phone:208-734-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW- 33027104100000X
IDLCSW-35305101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker