Provider Demographics
NPI:1407639529
Name:COLLIS, CARLI MARIE (MS, PLPC)
Entity Type:Individual
Prefix:MISS
First Name:CARLI
Middle Name:MARIE
Last Name:COLLIS
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 METAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4034
Mailing Address - Country:US
Mailing Address - Phone:504-517-2022
Mailing Address - Fax:
Practice Address - Street 1:619 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4034
Practice Address - Country:US
Practice Address - Phone:504-422-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health