Provider Demographics
NPI:1952187064
Name:COLES, JESSICA ANNE (LPC, CRC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:COLES
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 S GARFIELD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3456
Mailing Address - Country:US
Mailing Address - Phone:231-649-3535
Mailing Address - Fax:
Practice Address - Street 1:812 S GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3456
Practice Address - Country:US
Practice Address - Phone:231-649-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222774101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor