Provider Demographics
NPI:1407906019
Name:COCANOUGHER, HEATHER S (BA, PE)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:S
Last Name:COCANOUGHER
Suffix:
Gender:F
Credentials:BA, PE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 PERRYVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422
Mailing Address - Country:US
Mailing Address - Phone:859-936-3501
Mailing Address - Fax:859-538-1126
Practice Address - Street 1:1151 PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1306
Practice Address - Country:US
Practice Address - Phone:859-936-3501
Practice Address - Fax:859-538-1126
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0454Medicare ID - Type UnspecifiedMEDICARE