Provider Demographics
NPI:1922247832
Name:COLLINS, KIMBERLY DEE (MSED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSED, LPC, NCC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BRIDGMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:970-522-4211
Practice Address - Street 1:2864 S CIRCLE DRIVE
Practice Address - Street 2:SUITE 600
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-314-4260
Practice Address - Fax:719-264-6616
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-4727101YP2500X
CO4727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional