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General NPI Number Information
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NPI Number | 1881753978
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Entity Type | Individual
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Provider Name | JOHN B COCHRAN LCMHC
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 38 PARK PL
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City | BRATTLEBORO
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State | VT
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Zip | 05301-2827
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Country | US
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Telephone | 802-258-9896
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Fax |
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Provider Business Mailing Address
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Address Line | 6494 HINESBURG RD
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City | GUILFORD
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State | VT
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Zip | 05301-8293
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Country | US
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Telephone | 802-254-6985
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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 | 068-0000544
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License Number State | VT
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