Provider Demographics
NPI:1285185058
Name:CAUDILLO-COLE THERAPEUTIKS
Entity Type:Organization
Organization Name:CAUDILLO-COLE THERAPEUTIKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CREIGHTON
Authorized Official - Last Name:COLE
Authorized Official - Suffix:I
Authorized Official - Credentials:PHD/LMFT
Authorized Official - Phone:213-700-0007
Mailing Address - Street 1:167 N 3RD AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6052
Mailing Address - Country:US
Mailing Address - Phone:213-700-0007
Mailing Address - Fax:
Practice Address - Street 1:167 N 3RD AVE
Practice Address - Street 2:SUITE N
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6052
Practice Address - Country:US
Practice Address - Phone:213-700-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT32933251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health