Healthcare Provider Details

I. General information

NPI: 1871258079
Provider Name (Legal Business Name): MARY ELIZABETH COLE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6093 S QUEBEC ST STE 100
CENTENNIAL CO
80111-4543
US

IV. Provider business mailing address

6093 S QUEBEC ST STE 100
CENTENNIAL CO
80111-4543
US

V. Phone/Fax

Practice location:
  • Phone: 303-770-6933
  • Fax:
Mailing address:
  • Phone: 303-770-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: