Provider Demographics
NPI:1700187408
Name:COGAN, LEONARD (MA, LPC, CADC III)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:COGAN
Suffix:
Gender:M
Credentials:MA, LPC, CADC III
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 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:
Practice Address - Street 1:887 82ND DR
Practice Address - Street 2:BLDG C
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027
Practice Address - Country:US
Practice Address - Phone:503-659-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)