Provider Demographics
NPI:1841599552
Name:COLLINS, SHAUNTE' A (LPC)
Entity Type:Individual
Prefix:MISS
First Name:SHAUNTE'
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18240 MIDWAY RD
Mailing Address - Street 2:APT 1706
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4923
Mailing Address - Country:US
Mailing Address - Phone:972-743-9584
Mailing Address - Fax:
Practice Address - Street 1:1422 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3388
Practice Address - Country:US
Practice Address - Phone:469-549-4200
Practice Address - Fax:469-549-4201
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional