Provider Demographics
NPI:1487140752
Name:COLLIER, AQUEELAH R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AQUEELAH
Middle Name:R
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALLENTOWN PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4215
Mailing Address - Country:US
Mailing Address - Phone:817-504-7660
Mailing Address - Fax:214-623-6692
Practice Address - Street 1:100 ALLENTOWN PKWY STE 206
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002
Practice Address - Country:US
Practice Address - Phone:972-233-1010
Practice Address - Fax:214-623-6692
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA