Provider Demographics
NPI:1508443870
Name:COCKER, ASHLEY REBECCA (PSYD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REBECCA
Last Name:COCKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:REBECCA
Other - Last Name:COCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 2422
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91386-2422
Mailing Address - Country:US
Mailing Address - Phone:818-458-3689
Mailing Address - Fax:
Practice Address - Street 1:25583 AVENUE STANFORD STE 1B
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1101
Practice Address - Country:US
Practice Address - Phone:818-458-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32471103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist