Provider Demographics
NPI:1942576970
Name:COLLINS, JESSECA LAUREL (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSECA
Middle Name:LAUREL
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4108
Mailing Address - Country:US
Mailing Address - Phone:610-710-1441
Mailing Address - Fax:
Practice Address - Street 1:43 PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4108
Practice Address - Country:US
Practice Address - Phone:610-710-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9445103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst