Provider Demographics
NPI:1275295305
Name:COLLINS, NIKELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:NIKELLE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856-0403
Mailing Address - Country:US
Mailing Address - Phone:208-290-2840
Mailing Address - Fax:
Practice Address - Street 1:1717 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-9329
Practice Address - Country:US
Practice Address - Phone:208-265-6798
Practice Address - Fax:208-263-8160
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID41351104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker