Provider Demographics
NPI:1376504340
Name:VIVIAN A COLLINS PHD PC
Entity Type:Organization
Organization Name:VIVIAN A COLLINS PHD PC
Other - Org Name:COLLINS PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-327-8118
Mailing Address - Street 1:483 NEVA LANE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
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:SUITE 114
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-327-8118
Practice Address - Fax:903-327-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00265Medicare ID - Type Unspecified
P00265Medicare UPIN