Provider Demographics
NPI:1639116536
Name:COLLIER, JAN MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MARIE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GUM ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-6708
Mailing Address - Country:US
Mailing Address - Phone:850-897-7248
Mailing Address - Fax:
Practice Address - Street 1:222 GOVERNMENT AVE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1868
Practice Address - Country:US
Practice Address - Phone:850-678-1846
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6308OtherBLUE CROSS BLUE SHIELD