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1710023023 NPI number — JANE PHILLIPS COCKRUM PHD IN PSYCHOLOGY

NPI Number: 1710023023
Health Care Provider/Practitioner: JANE PHILLIPS COCKRUM PHD IN PSYCHOLOGY

Information about “1710023023” NPI (JANE PHILLIPS COCKRUM PHD IN PSYCHOLOGY) exists in 1710023023 in HTML format HTML  |  1710023023 in plain Text format TXT  |  1710023023 in PDF (Portable Document Format) PDF  |  1710023023 in an XML format XML  formats.

NPI Number : 1710023023 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710023023",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COCKRUM",
    "FirstName": "JANE",
    "MiddleName": "PHILLIPS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD IN PSYCHOLOGY",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4010 DUPONT CIRCLE",
    "SecondLineMailingAddress": "STE 230",
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40207",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-893-5255",
    "MailingAddressFaxNumber": "502-456-9603",
    "FirstLinePracticeLocationAddress": "4010 DUPONT CIRCLE",
    "SecondLinePracticeLocationAddress": "STE 230",
    "PracticeLocationAddressCityName": "LOUISVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40207",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "502-893-5255",
    "PracticeLocationAddressFaxNumber": "502-456-9603",
    "EnumerationDate": "01/30/2007",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "39000259A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "LPCC0072",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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