Healthcare Provider Details

I. General information

NPI: 1053947804
Provider Name (Legal Business Name): CHANNING JOVI COCHRAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

5114 MEDICAL DR APT 2352
SAN ANTONIO TX
78229-3878
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 256-651-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11454015-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: