Provider Demographics
NPI:1861527608
Name:COHEN, IRAN NEAL (PHD)
Entity type:Individual
Prefix:DR
First Name:IRAN
Middle Name:NEAL
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-882-9734
Mailing Address - Fax:417-326-4707
Practice Address - Street 1:1736 E SUNSHINE ST
Practice Address - Street 2:STE 510
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1331
Practice Address - Country:US
Practice Address - Phone:417-882-9734
Practice Address - Fax:417-326-4707
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6157984OtherUBH
MO14312OtherBC
MOR00673OtherPREMIER
MO492904404Medicaid
MO000070046Medicare ID - Type Unspecified