Provider Demographics
NPI:1255418141
Name:COLLINS, PATRICIA (MA LP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7372 KIRKWOOD CT
Mailing Address - Street 2:INNOVATIVE PSYCHOLOGICAL CONSULTANTS
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5202
Mailing Address - Country:US
Mailing Address - Phone:763-416-4167
Mailing Address - Fax:763-416-4137
Practice Address - Street 1:7372 KIRKWOOD CT
Practice Address - Street 2:INNOVATIVE PSYCHOLOGICAL CONSULTANTS
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5202
Practice Address - Country:US
Practice Address - Phone:763-416-4167
Practice Address - Fax:763-416-4137
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 1209103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling