Provider Demographics
NPI:1538313762
Name:COBB, ALISON M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:M
Last Name:COBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HICKORY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1896
Mailing Address - Country:US
Mailing Address - Phone:406-546-2222
Mailing Address - Fax:
Practice Address - Street 1:121 HICKORY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1896
Practice Address - Country:US
Practice Address - Phone:406-546-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT391103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011002151Medicare PIN