Provider Demographics
NPI:1407081102
Name:COLLINS, KERRY ANNE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANNE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:5467 UPPER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1854
Mailing Address - Country:US
Mailing Address - Phone:716-439-7400
Mailing Address - Fax:
Practice Address - Street 1:5467 UPPER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1854
Practice Address - Country:US
Practice Address - Phone:716-493-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health