Provider Demographics
NPI:1316187321
Name:COGNITIVE DEVELOPMENT CENTER OF MONROE
Entity Type:Organization
Organization Name:COGNITIVE DEVELOPMENT CENTER OF MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-387-1304
Mailing Address - Street 1:PO BOX 7563
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-7563
Mailing Address - Country:US
Mailing Address - Phone:318-387-1304
Mailing Address - Fax:318-387-1306
Practice Address - Street 1:410 E ASKEW ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3706
Practice Address - Country:US
Practice Address - Phone:318-574-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health