Provider Demographics
NPI:1982037628
Name:COBURN, JEFFREY RYAN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RYAN
Last Name:COBURN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROCK RD
Mailing Address - Street 2:130
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2203
Mailing Address - Country:US
Mailing Address - Phone:316-530-2615
Mailing Address - Fax:316-613-2667
Practice Address - Street 1:250 N ROCK RD
Practice Address - Street 2:130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2203
Practice Address - Country:US
Practice Address - Phone:620-262-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist