Provider Demographics
NPI:1629406186
Name:COBB, CASEY (MA LPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5629
Mailing Address - Country:US
Mailing Address - Phone:214-635-9014
Mailing Address - Fax:
Practice Address - Street 1:5750 GENESIS CT STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4163
Practice Address - Country:US
Practice Address - Phone:469-200-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional