MEDICARE: COGNITIVE DEVELOPMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	ADC 11719	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467559690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGNITIVE DEVELOPMENT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 7563
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71211-7563
Country	:	US
Telephone Number	:	318-387-1304
Fax Number	:	318-387-1306

Provider Business Practice Location Address
First Line	:	1816 ROSELAWN AVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5434
Country	:	US
Telephone Number	:	318-387-1304
Fax Number	:	318-387-1306

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ADRIAN FISHER
Credential	:
Telephone Number	:	318-387-1304

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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