MEDICARE: BRENDA COCO-TURNER

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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor		LA

General Provider Information

NPI Number	:	1790156727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA COCO-TURNER

Provider Business Mailing Address
First Line	:	2175 STOCKWELL RD APT 1327
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5767
Country	:	US
Telephone Number	:	318-359-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	2175 STOCKWELL RD. APT. 1327
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111
Country	:	US
Telephone Number	:	318-359-8970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	08/15/2019

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