Provider Demographics
NPI:1790490084
Name:BROBST, CODY ALAN (MA)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:ALAN
Last Name:BROBST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 N 9TH ST STE 260
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2208
Mailing Address - Country:US
Mailing Address - Phone:260-409-4408
Mailing Address - Fax:
Practice Address - Street 1:54 N 9TH ST STE 260
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2208
Practice Address - Country:US
Practice Address - Phone:260-409-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral