Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 241 | MT |
N | 101YS0200X | School Counselor | MT | |
N | 103TS0200X | School Psychologist | MT |
NPI | 1134338726 |
---|---|
Provider Name | Mr. Douglas Shepard Cochran-Roberts |
First Address | Missoula, MT 59804-1208 |
Second Address | Missoula, MT 59804-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
241 | LCPC LICENSE NUMBER (01) | MT |