Provider Demographics
NPI:1770728164
Name:COLLINS, GLENDA (LPC)
Entity type:Individual
Prefix:MS
First Name:GLENDA
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 1:205 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-1616
Mailing Address - Country:US
Mailing Address - Phone:817-219-8900
Mailing Address - Fax:817-579-9242
Practice Address - Street 1:205 BONITA DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-1616
Practice Address - Country:US
Practice Address - Phone:817-219-8900
Practice Address - Fax:817-579-9242
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1471229 01OtherNHIC