Provider Demographics
NPI:1700125812
Name:COLE, MELODY JOY (LPC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:JOY
Last Name:COLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LARAMIE ST
Mailing Address - Street 2:APT 317
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5586
Mailing Address - Country:US
Mailing Address - Phone:620-218-4581
Mailing Address - Fax:785-579-5456
Practice Address - Street 1:425 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3686
Practice Address - Country:US
Practice Address - Phone:785-236-1178
Practice Address - Fax:785-579-5456
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional