Provider Demographics
NPI:1033834007
Name:COCHRANE, KELSEY E (BS)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23380 N 61ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5748
Mailing Address - Country:US
Mailing Address - Phone:602-358-7073
Mailing Address - Fax:888-927-0409
Practice Address - Street 1:14040 N CAVE CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6179
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:888-927-0409
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12-16-2016OtherNORTHERN ARIZONA UNIVERSITY