Provider Demographics
NPI:1336331503
Name:COGNITIVE BEHAVIORAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:COGNITIVE BEHAVIORAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-333-8287
Mailing Address - Street 1:2121 UNIVERSITY PARK DR
Mailing Address - Street 2:STE 110
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6901
Mailing Address - Country:US
Mailing Address - Phone:517-333-8287
Mailing Address - Fax:517-333-8295
Practice Address - Street 1:2121 UNIVERSITY PARK DR
Practice Address - Street 2:STE 110
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6901
Practice Address - Country:US
Practice Address - Phone:517-333-8287
Practice Address - Fax:517-333-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION14880Medicare PIN