Provider Demographics
NPI:1902986706
Name:COLLINS, REBECCA ADAIR (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ADAIR
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18363 COUNTY ROAD 1560
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1319
Mailing Address - Country:US
Mailing Address - Phone:580-436-9341
Mailing Address - Fax:
Practice Address - Street 1:305 S TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6429
Practice Address - Country:US
Practice Address - Phone:580-436-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1021OtherLICENSED PSYCHOLOGIST