Provider Demographics
NPI:1154647493
Name:COCHRAN, MARTIN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LADC
Mailing Address - Street 1:2212 NW 50TH ST
Mailing Address - Street 2:SUITE 241C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8086
Mailing Address - Country:US
Mailing Address - Phone:405-842-7284
Mailing Address - Fax:405-418-0324
Practice Address - Street 1:2212 NW 50TH ST
Practice Address - Street 2:SUITE 241C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8086
Practice Address - Country:US
Practice Address - Phone:405-842-7284
Practice Address - Fax:405-418-0324
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK195101YA0400X
OK2444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)