Provider Demographics
NPI:1538145065
Name:COLLINS, CONNIE S (LPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:S
Other - Last Name:BYINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3609
Mailing Address - Country:US
Mailing Address - Phone:573-201-6125
Mailing Address - Fax:
Practice Address - Street 1:1320 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3609
Practice Address - Country:US
Practice Address - Phone:573-201-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional