MEDICARE: MR. THOMAS GERARD COOGAN JR. MA, LPC

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	101YP2500X	Professional Counselor	6563	NC

General Provider Information

NPI Number	:	1881897320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS GERARD COOGAN JR. MA, LPC

Provider Business Mailing Address
First Line	:	4909 WATERS EDGE DR
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27606-2462
Country	:	US
Telephone Number	:	919-538-3458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4909 WATERS EDGE DR STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-2462
Country	:	US
Telephone Number	:	919-538-3458
Fax Number	:	888-325-6160

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	05/05/2018

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