Healthcare Provider Details

I. General information

NPI: 1780774554
Provider Name (Legal Business Name): DOUGLAS GENE COLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 MERRIMAN RD #100
AKRON OH
44313-5296
US

IV. Provider business mailing address

1755 MERRIMAN RD #100
AKRON OH
44313-5296
US

V. Phone/Fax

Practice location:
  • Phone: 330-836-8090
  • Fax: 330-867-8432
Mailing address:
  • Phone: 330-836-8090
  • Fax: 330-867-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: