Provider Demographics
NPI:1184468365
Name:COBORN, DANIEL RAY JR (LPC ASSOCIATE)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:COBORN
Suffix:JR
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 AVERY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6924
Mailing Address - Country:US
Mailing Address - Phone:512-461-2646
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290 STE F102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1042
Practice Address - Country:US
Practice Address - Phone:512-561-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95270101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty