Healthcare Provider Details

I. General information

NPI: 1730863184
Provider Name (Legal Business Name): CARRIE COCHRAN, MFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-216 FARRINGTON HWY
WAIALUA HI
96791-1241
US

IV. Provider business mailing address

PO BOX 911241
WAIALUA HI
96791-1241
US

V. Phone/Fax

Practice location:
  • Phone: 808-542-3030
  • Fax:
Mailing address:
  • Phone: 808-542-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE COCHRAN
Title or Position: LMFT
Credential: LMFT
Phone: 808-542-3030