Healthcare Provider Details

I. General information

NPI: 1790829646
Provider Name (Legal Business Name): COGNITIVE INSTITUTE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 POLK ST
MANSFIELD LA
71052
US

IV. Provider business mailing address

809 POLK ST
MANSFIELD LA
71052-2413
US

V. Phone/Fax

Practice location:
  • Phone: 318-871-5566
  • Fax: 318-871-1076
Mailing address:
  • Phone: 318-871-5566
  • Fax: 318-871-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1544710
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783518
License Number StateLA

VIII. Authorized Official

Name: MARLENA LAIRD
Title or Position: CEO
Credential:
Phone: 318-871-5566