Provider Demographics
NPI:1740206432
Name:COBLE, LINDA M (EDD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:COBLE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8600 ACADEMY RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1107
Mailing Address - Country:US
Mailing Address - Phone:505-821-3628
Mailing Address - Fax:505-856-7103
Practice Address - Street 1:4601 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2626
Practice Address - Country:US
Practice Address - Phone:505-821-3628
Practice Address - Fax:505-856-7103
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPSY424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
348612205Medicare ID - Type Unspecified