Provider Demographics
NPI:1376887000
Name:COLLINS, TRICIA LANE (LMFT)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LANE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-0988
Mailing Address - Country:US
Mailing Address - Phone:256-341-0811
Mailing Address - Fax:256-341-9358
Practice Address - Street 1:400 GRANT ST SE # A2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3004
Practice Address - Country:US
Practice Address - Phone:256-341-0811
Practice Address - Fax:256-341-9358
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL600860911OtherMAGELLAN
AL51131327OtherBCBS
AL846792OtherVALUE OPTIONS