Provider Demographics
NPI:1093438798
Name:COLLINS, BRENDON MICHAEL (MED, PLPC)
Entity Type:Individual
Prefix:MR
First Name:BRENDON
Middle Name:MICHAEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 NANA LN
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4627
Mailing Address - Country:US
Mailing Address - Phone:314-303-8388
Mailing Address - Fax:
Practice Address - Street 1:320 GRAVOIS RD STE 230
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4122
Practice Address - Country:US
Practice Address - Phone:636-600-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health