Provider Demographics
NPI:1063494482
Name:COGSWELL, MIMI ANN (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:MIMI
Middle Name:ANN
Last Name:COGSWELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17520 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-8523
Mailing Address - Country:US
Mailing Address - Phone:503-740-5742
Mailing Address - Fax:503-722-3964
Practice Address - Street 1:714B MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1821
Practice Address - Country:US
Practice Address - Phone:503-740-5742
Practice Address - Fax:503-722-3964
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health