Provider Demographics
NPI:1215300652
Name:COLE, AMANDA JAYNE (MA LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JAYNE
Last Name:COLE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JAYNE
Other - Last Name:OSBORNE RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LLPC
Mailing Address - Street 1:530 S HIGBEE ST
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-1318
Mailing Address - Country:US
Mailing Address - Phone:616-481-4185
Mailing Address - Fax:
Practice Address - Street 1:500 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1824
Practice Address - Country:US
Practice Address - Phone:231-468-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional