Provider Demographics
NPI:1598387219
Name:COCHRAN, ROBERT DEAN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEAN
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 S HOLLAND LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2007
Mailing Address - Country:US
Mailing Address - Phone:316-796-5775
Mailing Address - Fax:
Practice Address - Street 1:551 S HOLLAND LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2007
Practice Address - Country:US
Practice Address - Phone:316-796-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)