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NPI Code Detail

MEDICARE: MR. MITCHELL R COHEN SAC-IT, PCTL

MEDICARE: MR. MITCHELL R COHEN SAC-IT, PCTL
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
1101YA0400XAddiction (Substance Use Disorder) Counselor16612-130WI
2101YM0800XMental Health Counselor1858-226WI
3101YP1600XPastoral Counselor

General Provider Information

NPI Number : 1922448885
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MITCHELL R COHEN SAC-IT, PCTL
Provider Business Mailing Address
First Line : 500 W. SILVER SPRING RD
Second Line : SUITE 200
City : GLENDALE
State : WI
Zip : 53217-4300
Country : US
Telephone Number : 414-847-6253
Fax Number : 414-501-2361
Provider Business Practice Location Address
First Line : 500 W SILVER SPRING DR
Second Line : SUITE 200
City : GLENDALE
State : WI
Zip : 53217-5051
Country : US
Telephone Number : 414-847-6253
Fax Number : 414-501-2361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2013
Last Update Date : 06/25/2014

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