Provider Demographics
NPI:1720594567
Name:COLLIER, EDNA L
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:L
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 1:2750 S DURANGO DR BLDG 5-2058
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2636
Mailing Address - Country:US
Mailing Address - Phone:702-969-3861
Mailing Address - Fax:
Practice Address - Street 1:2750 S DURANGO DR BLDG 5-2058
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2636
Practice Address - Country:US
Practice Address - Phone:702-969-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health