Provider Demographics
NPI:1811900566
Name:COLE, CARRIE ULLRICH (MED)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ULLRICH
Last Name:COLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13718 SHADOW FALLS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3502
Mailing Address - Country:US
Mailing Address - Phone:281-486-1903
Mailing Address - Fax:281-480-0202
Practice Address - Street 1:1560 W. BAY AREA BLVD.
Practice Address - Street 2:SUITE 310
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2674
Practice Address - Country:US
Practice Address - Phone:281-480-0200
Practice Address - Fax:281-480-0202
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84910LOtherBLUE CROSS BLUE SHIELD
TX191853OtherVALUE OPTIONS PROVIDER