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NPI Code Detail

MEDICARE: TYLER JAMES COCHRAN

MEDICARE: TYLER JAMES COCHRAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1043783921
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER JAMES COCHRAN
Provider Business Mailing Address
First Line : 3001 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8685
Country : US
Telephone Number : 573-686-1200
Fax Number :
Provider Business Practice Location Address
First Line : 14148 MAGNOLIA BLVD STE 103
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91423-6414
Country : US
Telephone Number : 818-933-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2019
Last Update Date : 11/18/2024

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