MEDICARE: JIMMIE COSBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1265363261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMIE COSBY

Provider Business Mailing Address
First Line	:	2550 N HOLLYWOOD WAY STE 301
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-5025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 W CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5306
Country	:	US
Telephone Number	:	844-263-1613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ JIMMIE COSBY ” Practice Location

Language	Start Address	Practice Location

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