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General NPI Number Information
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NPI Number | 1760042949
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Entity Type | Individual
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Provider Name | TIA LYNAE COCHRAN
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 2650 W MONTROSE AVE STE 307
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City | CHICAGO
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State | IL
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Zip | 60618-1561
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Country | US
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Telephone | 773-217-9249
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 UPLAND DR PMB 6900
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City | HOUSTON
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State | TX
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Zip | 77043-4718
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Country | US
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Telephone | 773-217-9178
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.012407
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License Number State | IL
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