Basic Information
| Provider Information | |||||||||
| NPI: | 1790829646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COGNITIVE INSTITUTE INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 POLK ST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710522413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188715566 | ||||||||
| FaxNumber: | 3188711076 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 POLK ST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188715566 | ||||||||
| FaxNumber: | 3188711076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | MARLENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3186210910 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1544710 | LA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | 2203783518 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1544710 | 05 | LA | MEDICAID | 4503625 | 01 | LA | SUBMITTER NUMBER | OTHER |