Healthcare Provider Details

I. General information

NPI: 1881202042
Provider Name (Legal Business Name): SARA L COLE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 E EDNA AVE STE 101
PHOENIX AZ
85032-2127
US

IV. Provider business mailing address

7849 W MAUI LN
PEORIA AZ
85381-3411
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-5474
  • Fax:
Mailing address:
  • Phone: 623-308-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005282
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: