Provider Demographics
NPI:1013199082
Name:COBIELLA CENTER FOR CHANGE, INC.
Entity Type:Organization
Organization Name:COBIELLA CENTER FOR CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-225-1224
Mailing Address - Street 1:953 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4705
Mailing Address - Country:US
Mailing Address - Phone:772-225-1224
Mailing Address - Fax:
Practice Address - Street 1:953 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4705
Practice Address - Country:US
Practice Address - Phone:772-225-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL650238748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568551828OtherIND. NPI #
FL1285723668OtherIND. NPI #