Provider Demographics
NPI:1316143365
Name:COLE, DEBRA SUE (MED LPC BMC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUE
Last Name:COLE
Suffix:
Gender:F
Credentials:MED LPC BMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3420 TRAVIS COUNTRY CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6109
Mailing Address - Country:US
Mailing Address - Phone:512-899-8217
Mailing Address - Fax:512-899-2704
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:BLDG 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1120
Practice Address - Country:US
Practice Address - Phone:512-899-8217
Practice Address - Fax:512-899-2704
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX18179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist