Provider Demographics
NPI:1154559292
Name:COLE, HARRY SHELTON JR (LMFT)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:SHELTON
Last Name:COLE
Suffix:JR
Gender:M
Credentials:LMFT
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 579
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0579
Mailing Address - Country:US
Mailing Address - Phone:928-333-2683
Mailing Address - Fax:
Practice Address - Street 1:470 WEST CLEVELAND
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-4301
Practice Address - Fax:928-337-2269
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ941493Medicaid