Provider Demographics
NPI:1326595976
Name:COLLINS, MICHELLE JEANEA (LPC-INTERN, MED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEANEA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC-INTERN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9207 MCDADE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-2918
Mailing Address - Country:US
Mailing Address - Phone:832-794-2631
Mailing Address - Fax:
Practice Address - Street 1:21834 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:832-794-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional