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General NPI Number Information
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NPI Number | 1780900985
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Entity Type | Individual
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Provider Name | THERESA LYNN COLE MSC/CC
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Gender | Female
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE STE 213
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City | GLENDALE
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State | AZ
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Zip | 85308-8728
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Country | US
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Telephone | 602-541-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 E LEGACY DR UNIT 2113
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City | PHOENIX
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State | AZ
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Zip | 85042-6044
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Country | US
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Telephone | 602-541-2772
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Fax |
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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 | LPC-14542
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License Number State | AZ
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