Provider Demographics
NPI:1083191589
Name:COGNITIVE CONNECTIONS DIAGNOSTIC AND COUNSELING, LLC
Entity Type:Organization
Organization Name:COGNITIVE CONNECTIONS DIAGNOSTIC AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-914-0611
Mailing Address - Street 1:5877 LIVERNOIS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-3100
Mailing Address - Country:US
Mailing Address - Phone:312-914-0611
Mailing Address - Fax:312-929-0324
Practice Address - Street 1:5877 LIVERNOIS RD STE 104
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-3100
Practice Address - Country:US
Practice Address - Phone:313-550-0847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty