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General NPI Number Information
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NPI Number | 1679080600
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Entity Type | Individual
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Provider Name | KERMIT ANDREW COLE MFT
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Gender | Male
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 2930 FUEGO SAGRADO
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City | SANTA FE
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State | NM
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Zip | 87505-5114
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Country | US
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Telephone | 917-751-4366
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Fax | 917-751-4366
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Provider Business Mailing Address
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Address Line | 2930 FUEGO SAGRADO
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City | SANTA FE
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State | NM
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Zip | 87505-5114
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Country | US
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Telephone | 917-751-4366
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Fax | 917-751-4366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | CMF0199641
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License Number State | NM
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