Healthcare Provider Details

I. General information

NPI: 1134525207
Provider Name (Legal Business Name): COGITO MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 N FOSTER ST
DOTHAN AL
36303-4542
US

IV. Provider business mailing address

PO BOX 349
WEBB AL
36376-0349
US

V. Phone/Fax

Practice location:
  • Phone: 844-426-4486
  • Fax: 334-460-9993
Mailing address:
  • Phone: 386-530-0126
  • Fax: 334-460-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT ALAN GRIER
Title or Position: SOLE MEMBER
Credential: MS, LPC, NCC
Phone: 386-530-0126