Provider Demographics
NPI:1609878016
Name:COBB-DALTON, BETTY (LCSW,LISAC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:COBB-DALTON
Suffix:
Gender:F
Credentials:LCSW,LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14372 W KIOWA TRL
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:STE. 205
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4828
Practice Address - Country:US
Practice Address - Phone:623-556-9910
Practice Address - Fax:623-556-9910
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11448101YA0400X
AZLCSW-17021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ63676Medicare ID - Type Unspecified