=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205225455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TM COHEN & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2015
-----------------------------------------------------
Last Update Date | 01/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5209 YORK RD B-10
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21212-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-769-6402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5209 YORK RD B-10
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21212-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-769-6402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINCAL THERAPIST
-----------------------------------------------------
Name | TIESHA MIA COHEN
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 443-850-1701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC6047
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------