Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2381 | OK |
NPI | 1003171711 |
---|---|
Provider Name | Dr. Kelly Michelle Collins |
First Address | Choctaw, OK 73020-7481 |
Second Address | Choctaw, OK 73020-8428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 13/02/2013 |