Provider Demographics
NPI:1407480338
Name:COLLINS, LAUREN KRISTA
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W BATTLEFIELD ST APT E103
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4289
Mailing Address - Country:US
Mailing Address - Phone:417-860-0220
Mailing Address - Fax:
Practice Address - Street 1:2407 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2903
Practice Address - Country:US
Practice Address - Phone:417-413-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician