Provider Demographics
NPI:1285166066
Name:COLLINS-JACKSON, CYNTHIA (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:COLLINS-JACKSON
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 1:39 VILLAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3525
Mailing Address - Country:US
Mailing Address - Phone:936-202-0596
Mailing Address - Fax:936-666-2291
Practice Address - Street 1:39 VILLAGE HILL DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3525
Practice Address - Country:US
Practice Address - Phone:936-520-9124
Practice Address - Fax:936-666-2291
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health