MEDICARE: PRESTON COLES

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
1	101YP2500X	Professional Counselor	3688	LA

General Provider Information

NPI Number	:	1164730818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRESTON COLES

Provider Business Mailing Address
First Line	:	6840 N FIELDGATE CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-5453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 THIBODEAUX AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8271
Country	:	US
Telephone Number	:	225-610-5544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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Directions to “ PRESTON COLES ” Practice Location

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