Provider Demographics
NPI:1649540352
Name:COLLINS, ELAINE R (PHD, LMFC)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:R
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD, LMFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18340 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 107-280
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4058
Mailing Address - Country:US
Mailing Address - Phone:714-350-8634
Mailing Address - Fax:714-733-5699
Practice Address - Street 1:17817 SANTIAGO BLVD
Practice Address - Street 2:VILLA PARK MEDICAL
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861
Practice Address - Country:US
Practice Address - Phone:714-350-8634
Practice Address - Fax:714-733-5699
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist