MEDICARE: HEATHER REBECCA COLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1558563809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER REBECCA COLE

Provider Business Mailing Address
First Line	:	25 W ANAPAMU ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-5148
Country	:	US
Telephone Number	:	805-967-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 W ANAPAMU ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-5148
Country	:	US
Telephone Number	:	805-967-3486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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