Provider Demographics
NPI:1467671230
Name:COLLETTE, JASON EDWARD
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:EDWARD
Last Name:COLLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 SYLVAN RD
Mailing Address - Street 2:415
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-4400
Mailing Address - Country:US
Mailing Address - Phone:530-680-1222
Mailing Address - Fax:530-642-1233
Practice Address - Street 1:6692 MERCHANDISE WAY
Practice Address - Street 2:B
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9453
Practice Address - Country:US
Practice Address - Phone:530-626-2589
Practice Address - Fax:530-642-1233
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health