Provider Demographics
NPI:1831802693
Name:COLLINS, KIESHA (MA, CMHC, LPC)
Entity type:Individual
Prefix:
First Name:KIESHA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:
Credentials:MA, CMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W ELLIOT RD # 1257
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1107
Mailing Address - Country:US
Mailing Address - Phone:801-784-8238
Mailing Address - Fax:
Practice Address - Street 1:1110 W ELLIOT RD # 1257
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1107
Practice Address - Country:US
Practice Address - Phone:801-784-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019780101YP2500X
UT12665008-6004101YP2500X
AZLPC-23307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional