Provider Demographics
NPI:1083222608
Name:COBBS, KIMBRA (MHT)
Entity Type:Individual
Prefix:
First Name:KIMBRA
Middle Name:
Last Name:COBBS
Suffix:
Gender:F
Credentials:MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6683
Mailing Address - Country:US
Mailing Address - Phone:479-725-5115
Mailing Address - Fax:
Practice Address - Street 1:211 MISSOURI
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3707
Practice Address - Country:US
Practice Address - Phone:870-338-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician