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General NPI Number Information
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NPI Number | 1265737456
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Entity Type | Individual
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Provider Name | TIA M COCHRAN-OTIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 4333 E VINEYARD AVE
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City | OXNARD
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State | CA
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Zip | 93036-1013
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Country | US
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Telephone | 805-981-5572
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Fax |
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Provider Business Mailing Address
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Address Line | 4333 E VINEYARD AVE
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City | OXNARD
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State | CA
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Zip | 93036-1013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS26854
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 35673
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License Number State | ID
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