Provider Demographics
NPI:1912640384
Name:COLE, MADELINE ELISABETH
Entity Type:Individual
Prefix:MISS
First Name:MADELINE
Middle Name:ELISABETH
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 N RUDDELL ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-3368
Mailing Address - Country:US
Mailing Address - Phone:972-679-9593
Mailing Address - Fax:
Practice Address - Street 1:1702 N RUDDELL ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-3368
Practice Address - Country:US
Practice Address - Phone:972-679-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician