Provider Demographics
NPI:1811530280
Name:COLE, SHANTIK ALICIA (LPC)
Entity type:Individual
Prefix:
First Name:SHANTIK
Middle Name:ALICIA
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 1:11841 TOPPELL TRL
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-1509
Mailing Address - Country:US
Mailing Address - Phone:281-546-3965
Mailing Address - Fax:
Practice Address - Street 1:11841 TOPPELL TRL
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-1509
Practice Address - Country:US
Practice Address - Phone:281-546-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health