Provider Demographics
NPI:1124396395
Name:COLLINS, TEENA GAYE (MS,LPC,NCC)
Entity Type:Individual
Prefix:MS
First Name:TEENA
Middle Name:GAYE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-3218
Mailing Address - Country:US
Mailing Address - Phone:405-601-8655
Mailing Address - Fax:405-601-8655
Practice Address - Street 1:1720 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-3218
Practice Address - Country:US
Practice Address - Phone:405-601-8655
Practice Address - Fax:405-601-8655
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health