Provider Demographics
NPI:1871107912
Name:COLLINS, MARK STEVEN (LMFT #32049)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LMFT #32049
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 ATLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1631
Mailing Address - Country:US
Mailing Address - Phone:510-710-6428
Mailing Address - Fax:
Practice Address - Street 1:140 GREGORY LN STE 250
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3360
Practice Address - Country:US
Practice Address - Phone:925-798-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT32049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist