Provider Demographics
NPI:1891190690
Name:COLE, BRANDON (LPC, MHSP)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ROGOSIN DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2965
Mailing Address - Country:US
Mailing Address - Phone:423-433-9739
Mailing Address - Fax:
Practice Address - Street 1:204 ROGOSIN DR STE 4
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2965
Practice Address - Country:US
Practice Address - Phone:423-433-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional