Provider Demographics
NPI:1134338726
Name:COCHRAN-ROBERTS, DOUGLAS SHEPARD (LCPC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:SHEPARD
Last Name:COCHRAN-ROBERTS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 QUINN CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1208
Mailing Address - Country:US
Mailing Address - Phone:406-240-3510
Mailing Address - Fax:
Practice Address - Street 1:2651 QUINN CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1208
Practice Address - Country:US
Practice Address - Phone:406-240-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT241101YP2500X
MT101YS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT241OtherLCPC LICENSE NUMBER