Provider Demographics
NPI:1184106692
Name:COLLINS, AUDREY B
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:B
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 S JERICHO CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3871
Mailing Address - Country:US
Mailing Address - Phone:303-946-5221
Mailing Address - Fax:888-600-9221
Practice Address - Street 1:3856 S JERICHO CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3871
Practice Address - Country:US
Practice Address - Phone:303-946-5221
Practice Address - Fax:888-600-9221
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171000000X
CONLC.0012885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONONEOtherNONE