Provider Demographics
NPI:1740585405
Name:STARK, COLE LEE (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:LEE
Last Name:STARK
Suffix:
Gender:M
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 THOMPSON CREEK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5661
Mailing Address - Country:US
Mailing Address - Phone:402-326-4458
Mailing Address - Fax:
Practice Address - Street 1:5701 THOMPSON CREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5661
Practice Address - Country:US
Practice Address - Phone:402-326-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health