Provider Demographics
NPI:1376191098
Name:JAZZ & COCO LLC
Entity Type:Organization
Organization Name:JAZZ & COCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,NCC,MAC,LAC
Authorized Official - Phone:304-610-8661
Mailing Address - Street 1:289 HIGHWAY 90 E UNIT H
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-9298
Mailing Address - Country:US
Mailing Address - Phone:843-685-0998
Mailing Address - Fax:843-695-7681
Practice Address - Street 1:289 HIGHWAY 90 E UNIT H
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9298
Practice Address - Country:US
Practice Address - Phone:843-685-0998
Practice Address - Fax:843-695-7681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAZZ & COCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty