Provider Demographics
NPI:1366019713
Name:COLLETTI, NED LOUIS III (LAC)
Entity Type:Individual
Prefix:MR
First Name:NED
Middle Name:LOUIS
Last Name:COLLETTI
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 N 15TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4330
Mailing Address - Country:US
Mailing Address - Phone:310-744-5977
Mailing Address - Fax:
Practice Address - Street 1:7600 N 15TH ST UNIT 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5469
Practice Address - Country:US
Practice Address - Phone:602-704-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health