Provider Demographics
NPI:1821762790
Name:COSBY, ANNE CLAIRE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CLAIRE
Last Name:COSBY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 W LOUISIANA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5826
Mailing Address - Country:US
Mailing Address - Phone:432-684-4899
Mailing Address - Fax:432-684-4889
Practice Address - Street 1:2407 W LOUISIANA AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5826
Practice Address - Country:US
Practice Address - Phone:432-684-4899
Practice Address - Fax:432-684-4889
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-21-49397OtherTEXAS BCBA LICENSE