Provider Demographics
NPI:1174929558
Name:AWDISH, DAVID COLE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:COLE
Last Name:AWDISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 BAUER AVE
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-9255
Mailing Address - Country:US
Mailing Address - Phone:970-403-5485
Mailing Address - Fax:
Practice Address - Street 1:104 S. MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328-9033
Practice Address - Country:US
Practice Address - Phone:970-403-5488
Practice Address - Fax:970-422-7236
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health