Provider Demographics
NPI:1609375591
Name:COLES, PHILLIP J (BCBA,LBA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:COLES
Suffix:
Gender:M
Credentials:BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ANNAPOLIS RD. ST B2
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-850-1148
Mailing Address - Fax:866-250-3233
Practice Address - Street 1:9500 ANNAPOLIS RD. ST B2
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-850-1148
Practice Address - Fax:866-250-3233
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MDLBA1335103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician