Provider Demographics
NPI:1992551618
Name:COLLINS, HARLAN
Entity type:Individual
Prefix:
First Name:HARLAN
Middle Name:
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 1:2156 WOODDALE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1404
Mailing Address - Country:US
Mailing Address - Phone:225-930-8058
Mailing Address - Fax:225-351-8703
Practice Address - Street 1:2156 WOODDALE BLVD STE 750
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1404
Practice Address - Country:US
Practice Address - Phone:225-930-8058
Practice Address - Fax:225-351-8703
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty