Provider Demographics
NPI:1114706439
Name:STEPHANIE E. COLD LCPC, LLC
Entity Type:Organization
Organization Name:STEPHANIE E. COLD LCPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MED
Authorized Official - Phone:904-703-0762
Mailing Address - Street 1:1818 N SAWYER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6801
Mailing Address - Country:US
Mailing Address - Phone:904-703-0762
Mailing Address - Fax:
Practice Address - Street 1:1623 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5321
Practice Address - Country:US
Practice Address - Phone:312-521-0792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)