Individual
MR. MARK ALAN COGBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC,LMFT
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1595
LA
106H00000X
Marriage & Family Therapist
177
LA
364S00000X
Clinical Nurse Specialist
Primary
AP06313
LA
Other
Enumeration date
01/04/2007
Last updated
09/17/2024
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