Provider Demographics
NPI:1518197953
Name:COGMON, ROBERT LASTEVE
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LASTEVE
Last Name:COGMON
Suffix:
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 1:2975 PAY LESS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-7443
Mailing Address - Country:US
Mailing Address - Phone:702-576-2446
Mailing Address - Fax:866-929-4542
Practice Address - Street 1:2975 PAY LESS CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-7443
Practice Address - Country:US
Practice Address - Phone:702-576-2446
Practice Address - Fax:866-929-4542
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005051097Medicaid