Provider Demographics
NPI:1164724290
Name:COSBY, HEATHER ELIZABETH (LCDC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:COSBY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E BERRY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4300
Mailing Address - Country:US
Mailing Address - Phone:817-927-5441
Mailing Address - Fax:817-927-5442
Practice Address - Street 1:605 E BERRY ST STE 109
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4300
Practice Address - Country:US
Practice Address - Phone:817-927-5441
Practice Address - Fax:817-927-5442
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)