MEDICARE: MRS. SHARI HANNAH COBURN LPC

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	101Y00000X	Counselor	89844	TX
2	101YP2500X	Professional Counselor	14501	AZ

General Provider Information

NPI Number	:	1316713928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARI HANNAH COBURN LPC

Provider Business Mailing Address
First Line	:	4200 BRIDGEVIEW DR APT 1922
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5580
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 BRIDGEVIEW DR APT 1922
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5580
Country	:	US
Telephone Number	:	646-623-4984
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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