Provider Demographics
NPI:1710023023
Name:COCKRUM, JANE PHILLIPS (PHD IN PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:PHILLIPS
Last Name:COCKRUM
Suffix:
Gender:F
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4010 DUPONT CIRCLE
Mailing Address - Street 2:STE 230
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-893-5255
Mailing Address - Fax:502-456-9603
Practice Address - Street 1:4010 DUPONT CIRCLE
Practice Address - Street 2:STE 230
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-5255
Practice Address - Fax:502-456-9603
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN39000259A101YM0800X
KYLPCC0072103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist