MEDICARE: MS. THERESA KAY COLE LCSW

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	171M00000X	Case Manager/Care Coordinator	3266-P	OK

General Provider Information

NPI Number	:	1639269715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA KAY COLE LCSW

Provider Business Mailing Address
First Line	:	8717 NW 117TH CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1070
Country	:	US
Telephone Number	:	405-773-1793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 NW 50TH ST
Second Line	:	SUITE 246C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8086
Country	:	US
Telephone Number	:	405-879-3400
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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