Provider Demographics
NPI:1215394622
Name:COSSE', LARRY JR
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:COSSE'
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1705
Mailing Address - Country:US
Mailing Address - Phone:504-915-7926
Mailing Address - Fax:
Practice Address - Street 1:2151 SPYGLASS DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1705
Practice Address - Country:US
Practice Address - Phone:504-915-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator