Provider Demographics
NPI:1407051071
Name:COLES, ELIZABETH JEANNINE (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEANNINE
Last Name:COLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 N COLLINS BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3592
Mailing Address - Country:US
Mailing Address - Phone:215-577-7550
Mailing Address - Fax:
Practice Address - Street 1:5402 ARAPAHO RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-6905
Practice Address - Country:US
Practice Address - Phone:972-437-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61349101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186690701Medicaid
TX186690702Medicaid