Individual
GLENN COCKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LAC
Contact information
Practice address
1325 WYOMING ST, MISSOULA, MT 59801-1725
(406) 532-9800
(406) 541-3032
Mailing address
T-9 FORT MISSOULA, MISSOULA, MT 59804-7202
(406) 532-8400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1190
MT
1041C0700X
Clinical Social Worker
Primary
913
MT
Other
Enumeration date
04/11/2007
Last updated
11/30/2009
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