Provider Demographics
NPI:1477239606
Name:COBB, HENRY ALLEN
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:ALLEN
Last Name:COBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 E PECOS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6077
Mailing Address - Country:US
Mailing Address - Phone:480-846-0607
Mailing Address - Fax:480-841-6696
Practice Address - Street 1:2141 E PECOS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6077
Practice Address - Country:US
Practice Address - Phone:480-846-0607
Practice Address - Fax:480-841-6696
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician