Provider Demographics
NPI:1588227342
Name:COEN, MARK ANTHONY (LADC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:COEN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1821
Mailing Address - Country:US
Mailing Address - Phone:218-231-2413
Mailing Address - Fax:
Practice Address - Street 1:505 S 12TH AVE W
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3099
Practice Address - Country:US
Practice Address - Phone:218-749-2877
Practice Address - Fax:218-749-6033
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303198101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)