Provider Demographics
NPI:1780724534
Name:COHEN, JEFFREY M (LPC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:M
Other - Last Name:COHEN, LPC, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDIV, LPC
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402-1033
Mailing Address - Country:US
Mailing Address - Phone:573-578-5497
Mailing Address - Fax:
Practice Address - Street 1:1202 HOMELIFE PLZ
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2512
Practice Address - Country:US
Practice Address - Phone:573-578-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499304715Medicaid