Provider Demographics
NPI:1285630251
Name:COLLINS, VIVIAN ALICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:ALICE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 NEVA LN
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4871
Mailing Address - Country:US
Mailing Address - Phone:903-327-8118
Mailing Address - Fax:903-327-8474
Practice Address - Street 1:2402 W MORTON ST
Practice Address - Street 2:STE D-2
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1402
Practice Address - Country:US
Practice Address - Phone:903-327-8118
Practice Address - Fax:903-327-8474
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TX15523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00265PMedicare UPIN
TX00265PMedicare ID - Type Unspecified