Provider Demographics
NPI:1407066749
Name:CODY, CECILIE DAWN (MAAT, LPC)
Entity Type:Individual
Prefix:MS
First Name:CECILIE
Middle Name:DAWN
Last Name:CODY
Suffix:
Gender:F
Credentials:MAAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7475
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:907-225-4664
Mailing Address - Fax:907-885-6613
Practice Address - Street 1:2524 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-202-8741
Practice Address - Fax:907-202-8741
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP584101YM0800X, 101YP2500X
NM0101611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health