Provider Demographics
NPI:1699826057
Name:COBURN, VICTORIA B (LPC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:B
Last Name:COBURN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 ROYAL LN STE 216
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-7898
Mailing Address - Country:US
Mailing Address - Phone:214-696-9333
Mailing Address - Fax:214-692-6572
Practice Address - Street 1:5924 ROYAL LN STE 216
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-7898
Practice Address - Country:US
Practice Address - Phone:214-696-9333
Practice Address - Fax:214-692-6572
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health