Healthcare Provider Details

I. General information

NPI: 1275925315
Provider Name (Legal Business Name): PAUL COLE B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BALL AVE. .SE.
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

2444 HALL ST SE
GRAND RAPIDS MI
49506-3505
US

V. Phone/Fax

Practice location:
  • Phone: 616-581-5225
  • Fax:
Mailing address:
  • Phone: 616-581-5225
  • Fax: 616-456-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: