Healthcare Provider Details

I. General information

NPI: 1437528718
Provider Name (Legal Business Name): JAXON J KOBEY MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JENNIFER E COSBY LCSW

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N WILLIAMS ST UNIT C
MOBERLY MO
65270
US

IV. Provider business mailing address

1627 BOLD RULER CT
COLUMBIA MO
65202-3358
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-7651
  • Fax: 660-263-2815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2014001115
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017015858
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: