Provider Demographics
NPI:1316251002
Name:COLLINS, NITA JANECE
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:JANECE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 ANVIL PL APT A
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-2545
Mailing Address - Country:US
Mailing Address - Phone:405-229-6960
Mailing Address - Fax:
Practice Address - Street 1:121 TOWNSGATE PLZ
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3714
Practice Address - Country:US
Practice Address - Phone:575-742-2620
Practice Address - Fax:575-742-3182
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor