Provider Demographics
NPI:1780754564
Name:COZADD, DAVID LEE (LPC MED)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:COZADD
Suffix:
Gender:M
Credentials:LPC MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5633
Mailing Address - Country:US
Mailing Address - Phone:936-639-1141
Mailing Address - Fax:936-635-5695
Practice Address - Street 1:4101 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5633
Practice Address - Country:US
Practice Address - Phone:936-639-1141
Practice Address - Fax:936-635-5695
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80471LOtherBLUE CROSS BLUE SHIELD