MEDICARE: JULIUS ASVELT COCHRAN

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	101YM0800X	Mental Health Counselor	1075593-1-HCBS	MN
2	103K00000X	Behavior Analyst	1075593-1-HCBS	MN

General Provider Information

NPI Number	:	1447650775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIUS ASVELT COCHRAN

Provider Business Mailing Address
First Line	:	2530 17TH AVE NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-1621
Country	:	US
Telephone Number	:	612-558-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 N 4TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-2618
Country	:	US
Telephone Number	:	612-558-8915
Fax Number	:

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

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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