Evelyn S Cogdill, LPC
Individual provider Active NPI Counselor · Willow Park, TX
NPI 1669818852 · NPPES record last updated May 15, 2013
Key facts
- NPI
- 1669818852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 64147 (TX)
- Practice address
- 207 Canyon CT
Willow Park, TX 76087-3203 - Phone
- (817) 441-9345
- Fax
- (817) 441-2845
- NPI assigned
- May 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sondermind Provider Network LLC
Practice addresses (Care Compare)
2021 Guadalupe St
Suite 260
Austin, TX 78705-5654
Phone (866) 630-0966
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240320000644 | TX | Practitioner - Mental Health Counselor | 0446697957 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64147 | TX | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Current |
Accepting new patients |
Locations
2021 Guadalupe St
Ste 260
Austin, TX 78705
Phone (202) 932-9958
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 64147 | TX | Yes |
Addresses
Primary practice location
207 Canyon CT
Willow Park, TX 76087-3203
Mailing address
207 Canyon CT
Willow Park, TX 76087-3203
Phone (817) 441-9345
Other providers in Willow Park, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.