Provider Demographics
NPI:1457776254
Name:COSBY, KEVIN CHRISTOPHER (ACMHC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:COSBY
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 S REDWOOD RD UNIT 6B
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5495
Mailing Address - Country:US
Mailing Address - Phone:405-921-2679
Mailing Address - Fax:
Practice Address - Street 1:5667 S REDWOOD RD UNIT 6B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5495
Practice Address - Country:US
Practice Address - Phone:405-921-2679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2024-05-08
Deactivation Date:2017-12-08
Deactivation Code:
Reactivation Date:2024-05-08
Provider Licenses
StateLicense IDTaxonomies
UT8768739-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health