Provider Demographics
NPI:1730571340
Name:COLE, KELLIE ANN (MED)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26205 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1916
Mailing Address - Country:US
Mailing Address - Phone:832-534-3993
Mailing Address - Fax:281-292-2365
Practice Address - Street 1:26205 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1916
Practice Address - Country:US
Practice Address - Phone:832-534-3993
Practice Address - Fax:281-292-2365
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional