1720456213 NPI number — DR. MELANIE COLE LPC, NCC, ED D

Table of content: DR. MELANIE COLE LPC, NCC, ED D (NPI 1720456213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720456213 NPI number — DR. MELANIE COLE LPC, NCC, ED D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC, ED D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINICK
Provider Other First Name:
MELANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720456213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 MEMORIAL PKWY SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35802-4364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-533-1970
Provider Business Mailing Address Fax Number:
256-705-6477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 CEDAR SPRINGS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-502-0398
Provider Business Practice Location Address Fax Number:
256-600-8186
Provider Enumeration Date:
09/14/2015

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: 101YM0800X , with the licence number:  C2458A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 8724 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 330000014 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".