Provider Demographics
NPI:1053663534
Name:COGBURN, JONATHAN NELSON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:NELSON
Last Name:COGBURN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-4312
Mailing Address - Country:US
Mailing Address - Phone:325-200-7404
Mailing Address - Fax:
Practice Address - Street 1:1938 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4312
Practice Address - Country:US
Practice Address - Phone:325-200-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist