Provider Demographics
NPI:1164862843
Name:COCHRAN, STACI LEANN (MS)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:LEANN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-0099
Mailing Address - Country:US
Mailing Address - Phone:806-282-5439
Mailing Address - Fax:
Practice Address - Street 1:120 W. BROADWAY
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669-7366
Practice Address - Country:US
Practice Address - Phone:580-661-3588
Practice Address - Fax:580-661-3488
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
OK5838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool