Provider Demographics
NPI:1437240082
Name:COLLINS, JAMES AMBROSE (PHD LP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AMBROSE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N 33RD AVE
Mailing Address - Street 2:103
Mailing Address - City:ST CLOUD
Mailing Address - State:MD
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-253-3715
Mailing Address - Fax:320-252-2567
Practice Address - Street 1:325 N 33RD AVE
Practice Address - Street 2:103
Practice Address - City:ST CLOUD
Practice Address - State:MD
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-253-3715
Practice Address - Fax:320-252-2567
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist