Basic Information
| Provider Information | |||||||||
| NPI: | 1962492280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMHC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DELEON | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5201 E US HIGHWAY 36 | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461237837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177459555 | ||||||||
| FaxNumber: | 3177459565 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 TRACY RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | NEW WHITELAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461849699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654827421 | ||||||||
| FaxNumber: | 7654827462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39000263A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000000363881 | 01 | IN | ANTHEM BCBS | OTHER |