Provider Demographics
NPI:1790792117
Name:COLE, CHERYL LEE (LCPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LEE
Last Name:COLE
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18225 BURNHAM AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3059
Mailing Address - Country:US
Mailing Address - Phone:708-418-5227
Mailing Address - Fax:708-418-5237
Practice Address - Street 1:18225 BURNHAM AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3059
Practice Address - Country:US
Practice Address - Phone:708-418-5227
Practice Address - Fax:708-418-5237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632656OtherBLUE CROSS BLUE SHIELD