Provider Demographics
NPI:1811514615
Name:COLLINS PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:COLLINS PSYCHOTHERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-797-2200
Mailing Address - Street 1:6125 LUTHER LN # 328
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6202
Mailing Address - Country:US
Mailing Address - Phone:817-797-2200
Mailing Address - Fax:
Practice Address - Street 1:4237 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6739
Practice Address - Country:US
Practice Address - Phone:817-797-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8KE519OtherBCBS
TX00Q84XOtherBCBS
TX37807OtherLICENSE
TX8KE519Medicaid
TX0093ZEOtherBCBS
TX0093ZEMedicaid
TX36756OtherLICENSE