Individual
BRENDAN COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
781 KENMOOR AVE SE, GRAND RAPIDS, MI 49546-8628
(616) 200-4433
Mailing address
718 FAIRVIEW AVE NE # 2, GRAND RAPIDS, MI 49503-1521
(952) 288-9474
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BWW124050534001
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/02/2019
Last updated
06/02/2019
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