Provider Demographics
NPI:1447598107
Name:COLLIER, CECELIA RENEE
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:RENEE
Last Name:COLLIER
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 1:4009 CORTNEY CIR
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4743
Mailing Address - Country:US
Mailing Address - Phone:479-263-4948
Mailing Address - Fax:
Practice Address - Street 1:322D N BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9136
Practice Address - Country:US
Practice Address - Phone:479-263-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1512158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional