Provider Demographics
NPI:1467720060
Name:COLLINS, KEVIN BRENT (MA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BRENT
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 HAMILTON ACRES CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8623
Mailing Address - Country:US
Mailing Address - Phone:423-499-9335
Mailing Address - Fax:
Practice Address - Street 1:7209 HAMILTON ACRES CIR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8623
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003225101YM0800X
TNLPC3417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health