Individual
MR. JEFFREY BENNION COCKAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
496 A ST, IDAHO FALLS, ID 83402-3617
(208) 552-7100
(208) 552-7101
Mailing address
2200 S AMMON RD # 1, AMMON, ID 83406-6852
(208) 522-4795
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC - 3730
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80611000
—
ID
Enumeration date
03/20/2007
Last updated
07/09/2007
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