Provider Demographics
NPI:1083989552
Name:COLE, DENISE (MS MFT, LMFT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:MS MFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 CROCKER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MAZOMANIE
Mailing Address - State:WI
Mailing Address - Zip Code:53560-9425
Mailing Address - Country:US
Mailing Address - Phone:608-795-4141
Mailing Address - Fax:
Practice Address - Street 1:506 CROCKER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MAZOMANIE
Practice Address - State:WI
Practice Address - Zip Code:53560-9425
Practice Address - Country:US
Practice Address - Phone:608-795-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1012-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist