Keisha R. Collins

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C.2103532-TRNE Issued in OH

Practice address

169 Mansfield Ave
Shelby, OH 44875-1832

Phone

(567) 292-9211

NPI assigned

Apr 5, 2018

Last updated

Oct 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Life Counseling & Psychiatric Services

  • Addiction (Substance Use Disorder) Counselor
  • Mansfield, OH
  • NPI 1669731246
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1952807182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 MANSFIELD AVE",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 MANSFIELD AVE",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751832",
            "telephone_number": "567-292-9211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "KEISHA",
        "middle_name": "R.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.2103532-TRNE",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0290936",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Beth Close, LSW, LCDC III
• Keshawn Cobb
• Tremarous Cobb
• Alexander Cole
• Brandon Collins
• Michael Collins
• Allison Cook
• Cornell Abraxas Group, LLC (Abraxas Counseling Center)
• Cornell Abraxas Group, LLC
• Cornells Pharmacy LLC (Cornells Pharmacy)

• Mental Health Counselor in Shelby, OH
• Providers in Shelby, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.