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NPI Code Detail

MEDICARE: DAVID L COLE LCSW, LPHA

MEDICARE: DAVID L COLE LCSW, LPHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.011051IL

General Provider Information

NPI Number : 1164660775
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID L COLE LCSW, LPHA
Provider Business Mailing Address
First Line : PO BOX 163
Second Line : 12 W. HARRISON
City : SULLIVAN
State : IL
Zip : 61951-0163
Country : US
Telephone Number : 217-728-4358
Fax Number : 217-728-2270
Provider Business Practice Location Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number : 217-728-2270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2009
Last Update Date : 02/04/2009

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Directions to “ DAVID L COLE LCSW, LPHA” Practice Location

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