Provider Demographics
NPI:1841709243
Name:MOBBS, KODIE JO (LICSW)
Entity type:Individual
Prefix:
First Name:KODIE
Middle Name:JO
Last Name:MOBBS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KODIE
Other - Middle Name:JO
Other - Last Name:SHUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13799 N MATHESON RD
Mailing Address - Street 2:
Mailing Address - City:HAUSER
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5599
Mailing Address - Country:US
Mailing Address - Phone:509-386-2888
Mailing Address - Fax:
Practice Address - Street 1:23801 E APPLEWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9687
Practice Address - Country:US
Practice Address - Phone:509-386-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WASC609030291041C0700X
WALW613339901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health