Provider Demographics
NPI:1174674543
Name:COLE, ELAINE (MA)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10853 ROSE AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5372
Mailing Address - Country:US
Mailing Address - Phone:310-278-9997
Mailing Address - Fax:
Practice Address - Street 1:10853 ROSE AVE APT 19
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5372
Practice Address - Country:US
Practice Address - Phone:310-278-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist