Provider Demographics
NPI:1902197098
Name:S M COBB
Entity Type:Organization
Organization Name:S M COBB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-622-6437
Mailing Address - Street 1:400 N PENNSYLVANIA AVE STE 990
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4754
Mailing Address - Country:US
Mailing Address - Phone:575-622-6437
Mailing Address - Fax:
Practice Address - Street 1:400 N PENNSYLVANIA AVE STE 990
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4754
Practice Address - Country:US
Practice Address - Phone:575-622-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0005103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty