MEDICARE: PAMELA ROSANN COCHRAN LMHC

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	MH12361	FL
2	101YM0800X	Mental Health Counselor	MH12361	FL

General Provider Information

NPI Number	:	1497152953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ROSANN COCHRAN LMHC

Provider Business Mailing Address
First Line	:	7731 SW COLLINS ST
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34269-3402
Country	:	US
Telephone Number	:	941-457-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	3512 DEPEW AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-7015
Country	:	US
Telephone Number	:	941-286-2861
Fax Number	:

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

Provider Enumeration Date	:	11/28/2014
Last Update Date	:	11/28/2014

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