Provider Demographics
NPI:1245445204
Name:COCHRAN, TAHAMA EILEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:TAHAMA
Middle Name:EILEEN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMA
Other - Middle Name:E
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 20414
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0414
Mailing Address - Country:US
Mailing Address - Phone:405-922-4033
Mailing Address - Fax:
Practice Address - Street 1:11102 STRATFORD DR
Practice Address - Street 2:SUITE B-200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7260
Practice Address - Country:US
Practice Address - Phone:405-751-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical