Provider Demographics
NPI:1992703441
Name:COLLINS, BRENDA JOYCE (LMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 BROADWAY BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-3776
Mailing Address - Country:US
Mailing Address - Phone:972-864-8226
Mailing Address - Fax:775-414-5786
Practice Address - Street 1:2940 BROADWAY BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3776
Practice Address - Country:US
Practice Address - Phone:972-864-8226
Practice Address - Fax:775-414-5786
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT010926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist