Basic Information
| Provider Information | |||||||||
| NPI: | 1770187908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCKEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 E BROAD ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432132086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146553345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2611 WAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454201833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372567801 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2020 | ||||||||
| LastUpdateDate: | 11/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.