Provider Demographics
NPI:1952775702
Name:COLLINS, RISE KEVALSHAR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RISE
Middle Name:KEVALSHAR
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RISE
Other - Middle Name:CHERYLYN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:229 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1813
Mailing Address - Country:US
Mailing Address - Phone:208-245-2951
Mailing Address - Fax:208-245-9303
Practice Address - Street 1:229 S 8TH ST
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1813
Practice Address - Country:US
Practice Address - Phone:208-245-2951
Practice Address - Fax:208-245-9303
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 336911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical