Provider Demographics
NPI:1649436288
Name:COCKREHAM, DEBORAH DIANE (LPC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DIANE
Last Name:COCKREHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5044 CINQUEFOIL LN UNIT F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4522
Mailing Address - Country:US
Mailing Address - Phone:307-287-7847
Mailing Address - Fax:307-635-3965
Practice Address - Street 1:601 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2746
Practice Address - Country:US
Practice Address - Phone:307-287-7847
Practice Address - Fax:307-635-3965
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4815101YP2500X
WYLPC-787101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional