Healthcare Provider Details

I. General information

NPI: 1770225724
Provider Name (Legal Business Name): LORI LYNN COBB MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LORI LYNN SCHELL

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 COURT ST
BINGHAMTON NY
13901-3515
US

IV. Provider business mailing address

164 WACCAMW MED PARK DR
CONWAY SC
29526-8903
US

V. Phone/Fax

Practice location:
  • Phone: 607-584-4465
  • Fax: 607-584-4480
Mailing address:
  • Phone: 843-347-5060
  • Fax: 843-347-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP114223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: