Basic Information
| Provider Information | |||||||||
| NPI: | 1972853406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLIER-MEEKS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 PACELLA PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814400400 | ||||||||
| FaxNumber: | 7814371220 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 PACELLA PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814400400 | ||||||||
| FaxNumber: | 7814371220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 110026265 | 05 | MA | MEDICAID |