Provider Demographics
NPI:1093871527
Name:COSBY, PATRICIA SUSAN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUSAN
Last Name:COSBY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-8377
Mailing Address - Country:US
Mailing Address - Phone:405-496-5521
Mailing Address - Fax:
Practice Address - Street 1:1201 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3705
Practice Address - Country:US
Practice Address - Phone:405-496-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional