Provider Demographics
NPI:1891100475
Name:COLE, KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-9710
Mailing Address - Country:US
Mailing Address - Phone:231-834-8119
Mailing Address - Fax:
Practice Address - Street 1:231 W PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8028
Practice Address - Country:US
Practice Address - Phone:231-652-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801075561104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker