Provider Demographics
NPI:1295858884
Name:COLE, JUDY M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:M
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 1:559 VINCENT STREET
Mailing Address - Street 2:ATTN: 21 MDOS/SGOW - MENTAL HEALTH
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-7804
Mailing Address - Fax:
Practice Address - Street 1:559 VINCENT STREET
Practice Address - Street 2:ATTN: 21 MDOS/SGOW - MENTAL HEALTH
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical