Provider Demographics
NPI:1255655080
Name:COLLINS, KIMBERLI DAYL (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:DAYL
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARK PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5354
Mailing Address - Country:US
Mailing Address - Phone:405-323-9297
Mailing Address - Fax:405-844-2593
Practice Address - Street 1:500 PARK PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5354
Practice Address - Country:US
Practice Address - Phone:405-323-9297
Practice Address - Fax:405-844-2593
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional