Provider Demographics
NPI:1750511317
Name:COLE, TIMOTHY L (MS, LCMFT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:COLE
Suffix:
Gender:M
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 W 160TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8100
Mailing Address - Country:US
Mailing Address - Phone:913-404-5232
Mailing Address - Fax:913-423-1230
Practice Address - Street 1:7500 W 160TH ST STE 100
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-8100
Practice Address - Country:US
Practice Address - Phone:913-404-5232
Practice Address - Fax:913-423-1230
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200613780BMedicaid