1669573770 NPI number — DR. JONATHAN D COLE PH.D.

Table of content: DR. JONATHAN D COLE PH.D. (NPI 1669573770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669573770 NPI number — DR. JONATHAN D COLE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
JONATHAN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669573770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLUEGRASS HEALTH PSYCHOLOGY, INC.
Provider Second Line Business Mailing Address:
4101 TATES CREEK CTR DR STE 150, PMB 123
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-3066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-1008
Provider Business Mailing Address Fax Number:
859-277-1083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLUEGRASS HEALTH PSYCHOLOGY, INC.
Provider Second Line Business Practice Location Address:
2220 YOUNG DRIVE
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40505-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-1008
Provider Business Practice Location Address Fax Number:
859-277-1083
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TH0004X , with the licence number:  1200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: 1200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0004X , with the licence number: 128960 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: 128960 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 1200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 128960 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89000749 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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