Provider Demographics
NPI:1467757120
Name:COLE, KEA' S (MA, PLPC)
Entity Type:Individual
Prefix:MS
First Name:KEA'
Middle Name:S
Last Name:COLE
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:MS
Other - First Name:KEA'
Other - Middle Name:S
Other - Last Name:GOODINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PLPC
Mailing Address - Street 1:3100 BROADWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2591
Mailing Address - Country:US
Mailing Address - Phone:816-285-1343
Mailing Address - Fax:816-931-4532
Practice Address - Street 1:3100 BROADWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2591
Practice Address - Country:US
Practice Address - Phone:816-285-1343
Practice Address - Fax:816-931-4532
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101Y00000X
MO2010039209101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor