Provider Demographics
NPI:1215446612
Name:COLE AWDISH LPC LLC
Entity type:Organization
Organization Name:COLE AWDISH LPC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:AWDISH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-403-5488
Mailing Address - Street 1:844 BAUER AVE
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-9255
Mailing Address - Country:US
Mailing Address - Phone:970-403-5488
Mailing Address - Fax:
Practice Address - Street 1:104 S. MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328
Practice Address - Country:US
Practice Address - Phone:970-403-5488
Practice Address - Fax:970-422-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty