Provider Demographics
NPI:1396581948
Name:COBURN, KOBIE HEARL (MS)
Entity type:Individual
Prefix:MR
First Name:KOBIE
Middle Name:HEARL
Last Name:COBURN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 GARRETTS FORK RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-8733
Mailing Address - Country:US
Mailing Address - Phone:304-784-1312
Mailing Address - Fax:
Practice Address - Street 1:1608 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-235-0026
Practice Address - Fax:304-235-0028
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)