Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003199688 |
---|---|
Provider Name | Mr. Kenneth Ray Cocio |
First Address | Stockton, CA 95202-1552 |
Second Address | Stockton, CA 95202-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 21/09/2011 |