Provider Demographics
NPI:1811240872
Name:COLE, GARY TODD (MED)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:TODD
Last Name:COLE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 S TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-8800
Mailing Address - Country:US
Mailing Address - Phone:903-818-2248
Mailing Address - Fax:
Practice Address - Street 1:142 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5008
Practice Address - Country:US
Practice Address - Phone:580-920-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor