Provider Demographics
NPI:1841469673
Name:COLE, HEATHER MCCULLOCH (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MCCULLOCH
Last Name:COLE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 TRINITY DR
Mailing Address - Street 2:SUITE B ROOM 3
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2226
Mailing Address - Country:US
Mailing Address - Phone:505-661-8098
Mailing Address - Fax:
Practice Address - Street 1:3250 TRINITY DR
Practice Address - Street 2:SUITE B ROOM 3
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2226
Practice Address - Country:US
Practice Address - Phone:505-661-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0107741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist