Healthcare Provider Details

I. General information

NPI: 1245445204
Provider Name (Legal Business Name): TAHAMA EILEEN COCHRAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMA E. COCHRAN LCSW

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11102 STRATFORD DR SUITE B-200
OKLAHOMA CITY OK
73120-7260
US

IV. Provider business mailing address

PO BOX 20414
OKLAHOMA CITY OK
73156-0414
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-4219
  • Fax:
Mailing address:
  • Phone: 405-922-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1426
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: