Healthcare Provider Details

I. General information

NPI: 1265854012
Provider Name (Legal Business Name): JOSEPH DUSTIN COBB LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 MCKINNEY AVE #102
DALLAS TX
75204-8212
US

IV. Provider business mailing address

4220 HERSCHEL AVE #712
DALLAS TX
75219-2359
US

V. Phone/Fax

Practice location:
  • Phone: 214-520-6308
  • Fax: 214-521-9172
Mailing address:
  • Phone: 662-316-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number57589
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: