Provider Demographics
NPI:1902386345
Name:COLLINS, CORYN (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:CORYN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DEER ST STE 9
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5450
Mailing Address - Country:US
Mailing Address - Phone:501-505-4020
Mailing Address - Fax:505-859-0060
Practice Address - Street 1:1105 DEER ST STE 9
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5450
Practice Address - Country:US
Practice Address - Phone:501-505-4020
Practice Address - Fax:505-859-0060
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1805047101YM0800X
ARM2101022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty