Provider Demographics
NPI:1710908124
Name:COLLIE, BARBARA B (LCSW-ACP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:COLLIE
Suffix:
Gender:F
Credentials:LCSW-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:MALAKOFF
Mailing Address - State:TX
Mailing Address - Zip Code:75148-4754
Mailing Address - Country:US
Mailing Address - Phone:903-675-8883
Mailing Address - Fax:
Practice Address - Street 1:308 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2510
Practice Address - Country:US
Practice Address - Phone:903-675-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0638595-01Medicaid
TX0638595-01Medicaid