Provider Demographics
NPI:1346588787
Name:COLLINGS, GRANT T
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:T
Last Name:COLLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4017
Mailing Address - Country:US
Mailing Address - Phone:417-347-7600
Mailing Address - Fax:417-347-9810
Practice Address - Street 1:3220 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4017
Practice Address - Country:US
Practice Address - Phone:417-347-7600
Practice Address - Fax:417-347-9810
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110223681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical