MEDICARE: MS. BRITTNIE A COCKRELL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	IMH19971	FL
2	101YM0800X	Mental Health Counselor	IMH19971	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376085183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRITTNIE A COCKRELL

Provider Business Mailing Address
First Line	:	25097 OLYMPIA AVE STE 205
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3912
Country	:	US
Telephone Number	:	941-347-8341
Fax Number	:	941-347-7702

Provider Business Practice Location Address
First Line	:	25097 OLYMPIA AVE STE 205
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3912
Country	:	US
Telephone Number	:	941-347-8341
Fax Number	:	941-347-7702

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

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	07/13/2021

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Directions to “ MS. BRITTNIE A COCKRELL ” Practice Location

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