MEDICARE: DR. SARA L COLE PSYD

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	103TC0700X	Clinical Psychologist	PSY-005282	AZ

General Provider Information

NPI Number	:	1881202042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA L COLE PSYD

Provider Business Mailing Address
First Line	:	7849 W MAUI LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-3411
Country	:	US
Telephone Number	:	623-308-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3933 E EDNA AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2127
Country	:	US
Telephone Number	:	602-633-5474
Fax Number	:

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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