1710570593 NPI number — KRISTIN LEE COCHRAN MFT

Table of content: PETER JOHN STAN OD (NPI 1710569819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710570593 NPI number — KRISTIN LEE COCHRAN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCHRAN
Provider First Name:
KRISTIN
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERWIN
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710570593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 DEUN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30157-3447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-616-2417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
02 W MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-332-7955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MFT002096 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFT002096 . This is a "MARRIAGE AND FAMILY THERAPIST LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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