Provider Demographics
NPI:1053418301
Name:COLLIER, JUDITH ANN (RN, BSN, MED LISAC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:RN, BSN, MED LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3872
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-3872
Mailing Address - Country:US
Mailing Address - Phone:928-532-3238
Mailing Address - Fax:928-532-3292
Practice Address - Street 1:1141 E. COOLEY ST.
Practice Address - Street 2:STE 0
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901
Practice Address - Country:US
Practice Address - Phone:928-532-3238
Practice Address - Fax:928-532-3292
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11458101YA0400X
AZLISAC11458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)