Provider Demographics
NPI:1588090237
Name:COLLINS, CARISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6125 LUTHER LN # 328
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6202
Mailing Address - Country:US
Mailing Address - Phone:817-797-2200
Mailing Address - Fax:
Practice Address - Street 1:4237 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6739
Practice Address - Country:US
Practice Address - Phone:817-779-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36756OtherLICENSED PSYCHOLOGIST