Provider Demographics
NPI:1255484242
Name:COLE, CHERYL REID (PSYD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:REID
Last Name:COLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 WEMBERLEY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3420
Mailing Address - Country:US
Mailing Address - Phone:502-412-8699
Mailing Address - Fax:
Practice Address - Street 1:3906 DUPONT SQ S STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4647
Practice Address - Country:US
Practice Address - Phone:502-896-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00141Medicare ID - Type UnspecifiedPART B