Provider Demographics
NPI:1790186104
Name:COBB, RONALD LEE (DMIN LCAC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:COBB
Suffix:
Gender:M
Credentials:DMIN LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11549 222ND RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8355
Mailing Address - Country:US
Mailing Address - Phone:785-305-0549
Mailing Address - Fax:
Practice Address - Street 1:11549 222ND RD
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8355
Practice Address - Country:US
Practice Address - Phone:785-305-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)