Provider Demographics
NPI:1013405331
Name:COLLINS, BRENDA LOUISE (LPC, BCMT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LOUISE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC, BCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 YACHT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5747
Mailing Address - Country:US
Mailing Address - Phone:469-769-1236
Mailing Address - Fax:
Practice Address - Street 1:6701 HERITAGE PKWY STE 170
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8798
Practice Address - Country:US
Practice Address - Phone:972-839-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional