Provider Demographics
NPI:1528197621
Name:COCHRANE, NICOLE TATIANA (MED, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:TATIANA
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:TATIANA
Other - Last Name:STEFANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:872 TAM O SHANTER CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-669-6033
Mailing Address - Fax:630-324-7147
Practice Address - Street 1:5117 MAIN ST.
Practice Address - Street 2:DG COMMONS LOWER LEVEL # 13
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-669-6033
Practice Address - Fax:630-324-7147
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006143101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2300602OtherCIGNA BEHAVIORAL HEALTH
IL02233003OtherBLUE CROSS BLUE SHIELD