Provider Demographics
NPI:1801218664
Name:COLLINS, JAMILL (MA, LMFT, LPHA)
Entity Type:Individual
Prefix:MR
First Name:JAMILL
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MA, LMFT, LPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 S CENTRAL PARK AVE
Mailing Address - Street 2:APT. 302
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-3669
Mailing Address - Country:US
Mailing Address - Phone:773-547-3688
Mailing Address - Fax:
Practice Address - Street 1:8324 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2545
Practice Address - Country:US
Practice Address - Phone:847-933-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist