Basic Information
| Provider Information | |||||||||
| NPI: | 1912460098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERS | ||||||||
| FirstName: | COLE | ||||||||
| MiddleName: | JEFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986602903 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986602903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606951325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2019 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | MC60986643 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.