Provider Demographics
NPI:1033694385
Name:COHEN, JEFFREY S (LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 E RAINTREE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2691
Mailing Address - Country:US
Mailing Address - Phone:602-751-8778
Mailing Address - Fax:
Practice Address - Street 1:8350 E RAINTREE DR STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2691
Practice Address - Country:US
Practice Address - Phone:602-751-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832079676OtherTAX ID NUMBER FOR BUSINESS