Healthcare Provider Details

I. General information

NPI: 1194367540
Provider Name (Legal Business Name): FARRELL COBBS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841 MAYFAIR DR APT 3
ANCHORAGE AK
99502-7247
US

IV. Provider business mailing address

7841 MAYFAIR DR APT 3
ANCHORAGE AK
99502-7247
US

V. Phone/Fax

Practice location:
  • Phone: 562-257-7295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: