Provider Demographics
NPI:1225166085
Name:COLLINS, MICHAEL D (MA, LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S MCCORMICK ST STE 206L
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4729
Mailing Address - Country:US
Mailing Address - Phone:928-777-0386
Mailing Address - Fax:928-445-8650
Practice Address - Street 1:141 S MCCORMICK ST STE 206L
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4729
Practice Address - Country:US
Practice Address - Phone:928-777-0386
Practice Address - Fax:928-445-8650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ152770Medicaid