Provider Demographics
NPI:1437528718
Name:KOBEY, JAXON J (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JAXON
Middle Name:J
Last Name:KOBEY
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:COSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1627 BOLD RULER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 N WILLIAMS ST UNIT C
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270
Practice Address - Country:US
Practice Address - Phone:660-263-7651
Practice Address - Fax:660-263-2815
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140011151041C0700X
MO20170158581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490043151Medicaid