Healthcare Provider Details

I. General information

NPI: 1164807277
Provider Name (Legal Business Name): FRANK KOBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N. 21ST STREET
NEWARK OH
43055
US

IV. Provider business mailing address

1625 WELSH HILLS RD
GRANVILLE OH
43023-9324
US

V. Phone/Fax

Practice location:
  • Phone: 740-349-6588
  • Fax:
Mailing address:
  • Phone: 614-288-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4616
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: