Provider Demographics
NPI:1417083262
Name:COLE, RONALD WALTON (LPC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WALTON
Last Name:COLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LONDONDERRY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7906
Mailing Address - Country:US
Mailing Address - Phone:254-776-0252
Mailing Address - Fax:254-776-0577
Practice Address - Street 1:305 LONDONDERRY DR STE 7
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7906
Practice Address - Country:US
Practice Address - Phone:254-776-0252
Practice Address - Fax:254-776-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1228LCOtherBCBS