Provider Demographics
NPI:1396477923
Name:COLLINS, GRACE MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 S BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1217
Mailing Address - Country:US
Mailing Address - Phone:712-260-1438
Mailing Address - Fax:
Practice Address - Street 1:2109 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-3730
Practice Address - Country:US
Practice Address - Phone:605-334-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20690101YP2500X
SDLPC20690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional