Provider Demographics
NPI:1356878649
Name:COYER, CODY LEE (BS, LADC)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:LEE
Last Name:COYER
Suffix:
Gender:M
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 BEMIDJI AVE N STE 13
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3884
Mailing Address - Country:US
Mailing Address - Phone:218-444-5740
Mailing Address - Fax:218-333-0241
Practice Address - Street 1:1510 BEMIDJI AVE N STE 13
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3884
Practice Address - Country:US
Practice Address - Phone:218-444-5740
Practice Address - Fax:218-333-0241
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304759101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)