Provider Demographics
NPI:1982480604
Name:COLE, CHRISTOPHER STEPHEN (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEPHEN
Last Name:COLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:STEPHEN
Other - Last Name:COLE CLEGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1135 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-2745
Mailing Address - Country:US
Mailing Address - Phone:208-705-6715
Mailing Address - Fax:
Practice Address - Street 1:1901 ALVIN RICKEN DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2727
Practice Address - Country:US
Practice Address - Phone:208-233-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health