Provider Demographics
NPI:1114712882
Name:COICOU, JAHCOB KRISTIAN
Entity type:Individual
Prefix:
First Name:JAHCOB
Middle Name:KRISTIAN
Last Name:COICOU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 NE 151ST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5849
Mailing Address - Country:US
Mailing Address - Phone:786-316-9003
Mailing Address - Fax:
Practice Address - Street 1:1254 NE 151ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-5849
Practice Address - Country:US
Practice Address - Phone:786-316-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician