MEDICARE: MARY JO COCHRUM LPC

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
1	101YP2500X	Professional Counselor	65647	TX

General Provider Information

NPI Number	:	1073364329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO COCHRUM LPC

Provider Business Mailing Address
First Line	:	2316 GARDEN LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3823
Country	:	US
Telephone Number	:	817-301-3078
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 W PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-3135
Country	:	US
Telephone Number	:	682-888-0733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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