Provider Demographics
NPI:1316007271
Name:COLLINS, GLENDA G (LPC LCDC)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:G
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 N GRANDVIEW
Mailing Address - Street 2:STE E
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3045
Mailing Address - Country:US
Mailing Address - Phone:432-550-3001
Mailing Address - Fax:432-550-3005
Practice Address - Street 1:1512 N GRANDVIEW
Practice Address - Street 2:STE E
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3045
Practice Address - Country:US
Practice Address - Phone:432-550-3001
Practice Address - Fax:432-550-3005
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7646101YA0400X
TX19394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206BOtherBCBS