Provider Demographics
NPI:1588871503
Name:COLLINS, JOE DAVID
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:DAVID
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001-E NORTH MESA
Mailing Address - Street 2:B 162
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932
Mailing Address - Country:US
Mailing Address - Phone:915-549-2868
Mailing Address - Fax:915-833-3227
Practice Address - Street 1:1418 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5618
Practice Address - Country:US
Practice Address - Phone:915-549-2868
Practice Address - Fax:915-833-3227
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health