Provider Demographics
NPI:1871010009
Name:COHEN, DURIEL ULYSSES
Entity Type:Individual
Prefix:MR
First Name:DURIEL
Middle Name:ULYSSES
Last Name:COHEN
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 1:1418 COLORADO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2213
Mailing Address - Country:US
Mailing Address - Phone:616-414-0019
Mailing Address - Fax:
Practice Address - Street 1:1500 E BELTLINE AVE SE STE 250
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4360
Practice Address - Country:US
Practice Address - Phone:616-414-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional