Provider Demographics
NPI:1841779444
Name:COLLINS, IVA (FAMILY SUPPORT PROVI)
Entity Type:Individual
Prefix:
First Name:IVA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:FAMILY SUPPORT PROVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-0000
Mailing Address - Country:US
Mailing Address - Phone:918-847-3527
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:401 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-0000
Practice Address - Country:US
Practice Address - Phone:918-847-3527
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator