Provider Demographics
NPI:1982856704
Name:COLLINSWORTH, JANICE GAYLE (BA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:GAYLE
Last Name:COLLINSWORTH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 COUNTY ROAD 4023
Mailing Address - Street 2:
Mailing Address - City:KEMP
Mailing Address - State:TX
Mailing Address - Zip Code:75143-9169
Mailing Address - Country:US
Mailing Address - Phone:903-498-8772
Mailing Address - Fax:
Practice Address - Street 1:106 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1928
Practice Address - Country:US
Practice Address - Phone:903-455-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker