Provider Demographics
NPI:1669106985
Name:CUSHENBERY, COBY JORDON (LMFT-T)
Entity type:Individual
Prefix:
First Name:COBY
Middle Name:JORDON
Last Name:CUSHENBERY
Suffix:
Gender:M
Credentials:LMFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 N WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2737
Mailing Address - Country:US
Mailing Address - Phone:316-670-6556
Mailing Address - Fax:
Practice Address - Street 1:7570 W 21ST ST N STE 1046A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1771
Practice Address - Country:US
Practice Address - Phone:316-749-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106H00000X
KS03409-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist