Provider Demographics
NPI:1922825272
Name:COLLINS, FLETCHER LEE JR (PMHNP)
Entity type:Individual
Prefix:MR
First Name:FLETCHER
Middle Name:LEE
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43544 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4572
Mailing Address - Country:US
Mailing Address - Phone:313-598-7523
Mailing Address - Fax:
Practice Address - Street 1:375 EUREKA RD STE B
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5839
Practice Address - Country:US
Practice Address - Phone:734-258-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704346698363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health