Healthcare Provider Details

I. General information

NPI: 1811878051
Provider Name (Legal Business Name): JONATHAN R COBB CT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 HIGH ST
BEDFORD OH
44146-3868
US

IV. Provider business mailing address

869 HIGH ST
BEDFORD OH
44146-3868
US

V. Phone/Fax

Practice location:
  • Phone: 440-622-7565
  • Fax:
Mailing address:
  • Phone: 440-343-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2506573-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: