Provider Demographics
NPI:1548300643
Name:COLLS, JOSE ELADIO
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ELADIO
Last Name:COLLS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:COLLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:59 JANELL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2255
Mailing Address - Country:US
Mailing Address - Phone:318-484-6210
Mailing Address - Fax:318-484-6844
Practice Address - Street 1:242 WEST SHAMROCK STREET
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6210
Practice Address - Fax:318-484-6844
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional