Provider Demographics
NPI:1578718912
Name:COLLASO, SHANNA RAE (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:RAE
Last Name:COLLASO
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SEAGAZE DR # 289
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3005
Mailing Address - Country:US
Mailing Address - Phone:702-321-8052
Mailing Address - Fax:
Practice Address - Street 1:130 S FIG ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4401
Practice Address - Country:US
Practice Address - Phone:760-741-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBACHELOR OF SCIENCE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)