Provider Demographics
NPI:1356442214
Name:COLLINS, LISA MARIE (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 WEST RIVER ROCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714
Mailing Address - Country:US
Mailing Address - Phone:406-599-7994
Mailing Address - Fax:
Practice Address - Street 1:129 VILLAGE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9618
Practice Address - Country:US
Practice Address - Phone:406-388-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health