Provider Demographics
NPI:1356879324
Name:COSME, ANGEL R
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:R
Last Name:COSME
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 1:4134 FLORIDA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2190
Mailing Address - Country:US
Mailing Address - Phone:504-441-5555
Mailing Address - Fax:504-441-5550
Practice Address - Street 1:4134 FLORIDA AVE STE 101
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2190
Practice Address - Country:US
Practice Address - Phone:504-441-5555
Practice Address - Fax:504-441-5550
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA111OtherCERTIFIED HYPNOTHERAPIST