Provider Demographics
NPI:1750897146
Name:COLLINS, KELLEY (LPC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
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 1:2023 W HOUSTON WAY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6933
Mailing Address - Country:US
Mailing Address - Phone:347-633-0494
Mailing Address - Fax:
Practice Address - Street 1:2023 W HOUSTON WAY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38139-6933
Practice Address - Country:US
Practice Address - Phone:347-633-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-1054331OtherFAMILIES FIRST