MEDICARE: MRS. HEATHER MCCULLOCH COLE MA, MFT

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	106H00000X	Marriage & Family Therapist	0107741	NM

General Provider Information

NPI Number	:	1841469673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER MCCULLOCH COLE MA, MFT

Provider Business Mailing Address
First Line	:	3250 TRINITY DR
Second Line	:	SUITE B ROOM 3
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2226
Country	:	US
Telephone Number	:	505-661-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 TRINITY DR
Second Line	:	SUITE B ROOM 3
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2226
Country	:	US
Telephone Number	:	505-661-8098
Fax Number	:

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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