Individual
MR. PHILLIP MICHAEL COCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
401 RAINBOW DR UNIT 6, PINEVILLE, LA 71360-6979
(318) 484-2168
(318) 487-5453
Mailing address
152 MAIN ST, MOREAUVILLE, LA 71355-2502
(318) 487-5191
(318) 487-5184
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAC #798
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9759
BLUECROSSBLUESHIELD
LA
Enumeration date
08/18/2006
Last updated
02/04/2010
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