Provider Demographics
NPI:1659642320
Name:COLLIER, MICHAEL (LPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
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Mailing Address - Street 1:5260 SAN ANSELMO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-2528
Mailing Address - Country:US
Mailing Address - Phone:805-642-7033
Mailing Address - Fax:805-642-7201
Practice Address - Street 1:5810 RALSTRON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-642-7033
Practice Address - Fax:805-624-7201
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA30793167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA167G00000XOtherLICENSED PSYCHIATRIC TECHNICIAN