Provider Demographics
NPI:1104981299
Name:COLLINS, DANA RENEE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:RENEE
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:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75120-0263
Mailing Address - Country:US
Mailing Address - Phone:469-337-7152
Mailing Address - Fax:972-875-3808
Practice Address - Street 1:219 W BROWN ST
Practice Address - Street 2:STE. A
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4738
Practice Address - Country:US
Practice Address - Phone:469-337-7152
Practice Address - Fax:972-875-3808
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159530801Medicaid