Active NPI
Clarissa Collins
- Mental Health Counselor
- Spokane, WA
National Provider Identifier
1194361436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC60999144
- Practice address
- 1404 E 11TH Ave
Spokane, WA 99202-3502 - Phone
- (509) 744-1117
- Fax
- (509) 744-3055
- NPI assigned
- Nov 21, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC60999144 | WA | Primary |
Addresses
Primary practice location
1404 E 11TH Ave
Spokane, WA 99202-3502
Mailing address
PO Box 3183
Spokane, WA 99220-3183
Phone (509) 744-1117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC60999144 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1194361436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3183",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992203183",
"telephone_number": "509-744-1117",
"fax_number": "509-744-3055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1404 E 11TH AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992023502",
"telephone_number": "509-744-1117",
"fax_number": "509-744-3055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "CLARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-21",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC60999144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.