Provider Demographics
NPI:1366621591
Name:COLLINS, JULIE DENISE (LPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:DENISE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2206
Mailing Address - Country:US
Mailing Address - Phone:209-557-9676
Mailing Address - Fax:
Practice Address - Street 1:1601 YOSEMITE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2800
Practice Address - Country:US
Practice Address - Phone:209-341-1824
Practice Address - Fax:209-523-1296
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29464101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor