Healthcare Provider Details

I. General information

NPI: 1427540913
Provider Name (Legal Business Name): RANDALL ERIC COLE LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6692 SPRING ARBOR RD
JACKSON MI
49201-9322
US

IV. Provider business mailing address

6692 SPRING ARBOR RD
JACKSON MI
49201-9322
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-3869
  • Fax: 517-750-3673
Mailing address:
  • Phone: 517-750-3869
  • Fax: 517-750-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: