Provider Demographics
NPI:1023228640
Name:COCHRAN, NOAL BAXTER (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:NOAL
Middle Name:BAXTER
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LAKELAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465
Mailing Address - Country:US
Mailing Address - Phone:601-297-1886
Mailing Address - Fax:
Practice Address - Street 1:80 LAKELAND CIRCLE
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465
Practice Address - Country:US
Practice Address - Phone:601-297-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0382106H00000X
GAMFT001031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist