Provider Demographics
NPI:1467774471
Name:COCKLEY, KURTZ RAYMOND (MA LMFT)
Entity Type:Individual
Prefix:MR
First Name:KURTZ
Middle Name:RAYMOND
Last Name:COCKLEY
Suffix:
Gender:M
Credentials:MA LMFT
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 165
Mailing Address - Street 2:
Mailing Address - City:LANDISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17040-0165
Mailing Address - Country:US
Mailing Address - Phone:717-789-2118
Mailing Address - Fax:717-789-2118
Practice Address - Street 1:107 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:LANDISBURG
Practice Address - State:PA
Practice Address - Zip Code:17040-0165
Practice Address - Country:US
Practice Address - Phone:717-789-2118
Practice Address - Fax:717-789-2118
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist