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General NPI Number Information
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NPI Number | 1780099705
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Entity Type | Individual
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Provider Name | COLE MODLIN MA
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Gender | Male
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 609 CHEEK SPARGER RD STE 112
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City | COLLEYVILLE
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State | TX
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Zip | 76034-3856
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Country | US
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Telephone | 682-999-8186
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Fax | 682-747-6887
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Provider Business Mailing Address
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Address Line | 7950 CRYSTAL CREEK CIR
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City | FORT WORTH
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State | TX
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Zip | 76137-5624
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Country | US
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Telephone | 682-999-8186
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Fax | 682-747-6887
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 68664
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License Number State | TX
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