Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003089780 |
---|---|
Provider Name | Jamie L Cole |
First Address | Fort Worth, TX 76104-2733 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 05/02/2010 |