Provider Demographics
NPI:1699499053
Name:COLLUM, PEYTON MACENZIE (LPC)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:MACENZIE
Last Name:COLLUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3642
Mailing Address - Country:US
Mailing Address - Phone:214-404-0098
Mailing Address - Fax:
Practice Address - Street 1:13720 MIDWAY RD STE 106207
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4313
Practice Address - Country:US
Practice Address - Phone:214-949-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health