MEDICARE: MARTIN COCHRAN MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	195	OK
2	101YM0800X	Mental Health Counselor	2444	OK

General Provider Information

NPI Number	:	1154647493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN COCHRAN MS, LPC

Provider Business Mailing Address
First Line	:	2212 NW 50TH ST
Second Line	:	SUITE 241C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8086
Country	:	US
Telephone Number	:	405-842-7284
Fax Number	:	405-418-0324

Provider Business Practice Location Address
First Line	:	2212 NW 50TH ST
Second Line	:	SUITE 241C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8086
Country	:	US
Telephone Number	:	405-842-7284
Fax Number	:	405-418-0324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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