Provider Demographics
NPI:1902100670
Name:COLE, JEFFREY MATTHEW (LPC, CACIII)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:COLE
Suffix:
Gender:M
Credentials:LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:SNOWMASS
Mailing Address - State:CO
Mailing Address - Zip Code:81654-0412
Mailing Address - Country:US
Mailing Address - Phone:303-815-9399
Mailing Address - Fax:
Practice Address - Street 1:430 W MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1616
Practice Address - Country:US
Practice Address - Phone:303-815-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7141101YA0400X
CO5714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)