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General NPI Number Information
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NPI Number | 1154551422
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Entity Type | Individual
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Provider Name | ROBERT COLLETTE LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 12302 KENNEDY DR
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City | PARKER
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State | AZ
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Zip | 85344-7833
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Country | US
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Telephone | 928-669-5243
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Fax |
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Provider Business Mailing Address
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Address Line | 2455 CAMINO LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5825
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Country | US
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Telephone | 928-453-0222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 12469
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2002030046
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 125
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License Number State | CO
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