Basic Information
| Provider Information | |||||||||
| NPI: | 1841605656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | ULAESE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S., M.H.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4308 76TH ST NE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982703720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253497352 | ||||||||
| FaxNumber: | 4253497366 | ||||||||
| Practice Location | |||||||||
| Address1: | 4308 76TH ST NE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982703720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253497352 | ||||||||
| FaxNumber: | 4253497366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2014 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60248632 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.