Provider Demographics
NPI:1275771404
Name:COCHRAN, RONALD E (NCC, LCPC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6311
Mailing Address - Country:US
Mailing Address - Phone:217-637-0229
Mailing Address - Fax:
Practice Address - Street 1:1509 W JOHN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3707
Practice Address - Country:US
Practice Address - Phone:217-637-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional