| Doctor Name: | MR. JASON EDWARD COLLETTE |
| NPI Number: | 1467671230 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 6692 Merchandise Way B Diamond Springs, CA - 956199453 |
| Business Phone Number: | 5306262589 |
| Business Fax Number: | 5306421233 |
| Mailing Address: | 6635 Sylvan Rd, 415 CITRUS HEIGHTS |
| State: | CA |
| Postal Code: | 956104400 |
| Phone Number: | 5306801222 |
| Fax Number: | 5306421233 |
| NPI Enumeration Date: | 04/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |