Provider Demographics
NPI:1316275647
Name:COLLINS, MELODIE KAY (MA, NCC)
Entity type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:KAY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:MELODIE
Other - Middle Name:KAY
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:
Practice Address - Street 1:6915 TUTT BLVD STE 110B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3591
Practice Address - Country:US
Practice Address - Phone:719-445-1292
Practice Address - Fax:719-591-6486
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001069106H00000X
COLPC.0006389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist