Provider Demographics
NPI:1558056226
Name:KOBAL, MADISON V I
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:V
Last Name:KOBAL
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 BARBSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1330
Mailing Address - Country:US
Mailing Address - Phone:484-464-5526
Mailing Address - Fax:
Practice Address - Street 1:13303 BARBSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77044-7704
Practice Address - Country:US
Practice Address - Phone:484-464-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health