Provider Demographics
NPI:1730552431
Name:COCKRELL, TONI (LPC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11780 W 118TH TER APT 127
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2074
Mailing Address - Country:US
Mailing Address - Phone:803-238-8128
Mailing Address - Fax:
Practice Address - Street 1:6720 W 121ST ST STE 101
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2035
Practice Address - Country:US
Practice Address - Phone:913-735-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional