Individual
MR. MITCHELL R COHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC-IT, PCTL
Contact information
Practice address
500 W SILVER SPRING DR, SUITE 200, GLENDALE, WI 53217-5051
(414) 847-6253
(414) 501-2361
Mailing address
500 W. SILVER SPRING RD, SUITE 200, GLENDALE, WI 53217-4300
(414) 847-6253
(414) 501-2361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16612-130
WI
101YM0800X
Mental Health Counselor
Primary
1858-226
WI
101YP1600X
Pastoral Counselor
—
—
Other
Enumeration date
06/25/2013
Last updated
06/25/2014
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