| Doctor Name: | DR. KELLY MICHELLE COLLINS |
| NPI Number: | 1003171711 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH. D., LPC NCC RPT |
| License Number: | 2381 |
| Business Practice Address: | 15803 Ne 23rd St # B Choctaw, OK - 730208428 |
| Business Phone Number: | 4056399999 |
| Business Fax Number: | |
| Mailing Address: | 623 N Carolyn Dr, CHOCTAW |
| State: | OK |
| Postal Code: | 730207481 |
| Phone Number: | 4054648679 |
| Fax Number: | |
| NPI Enumeration Date: | 07/09/2012 |
| NPI Last Update Date: | 02/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2381 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |