Provider Demographics
NPI:1588192207
Name:CLOUD, CODY ALLEN (MS)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ALLEN
Last Name:CLOUD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3905
Mailing Address - Country:US
Mailing Address - Phone:318-202-3706
Mailing Address - Fax:
Practice Address - Street 1:305 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3905
Practice Address - Country:US
Practice Address - Phone:318-202-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor