Provider Demographics
NPI:1457558538
Name:COHEN, MITCHELL H
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:H
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 1:3700 S WESTPORT AVE
Mailing Address - Street 2:SUITE # 1259
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-6360
Mailing Address - Country:US
Mailing Address - Phone:818-631-4175
Mailing Address - Fax:
Practice Address - Street 1:8127 MESA DR
Practice Address - Street 2:SUITE # B206-280
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8632
Practice Address - Country:US
Practice Address - Phone:818-631-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker