Most Relevant Information
Provider Data
| NPI Number: | 1003341686 |
| Provider Name: | KRYSTAL JACQUELLE COLLINS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/20/2017 |
| Last Updated: | 04/20/2017 |
Provider Practice Location
104 SASSAFRAS ST
AMITE
LA
704223425
Practice Location Phone/Fax
| Phone: | 2256448565 |
| Fax: | 2256446261 |
Provider Mailing Location
104 SASSAFRAS ST
AMITE
LA
704223425
Provider Mailing Phone/Fax
| Phone: | 2256448565 |
| Fax: | 2256446261 |