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General NPI Number Information
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NPI Number | 1669106985
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Entity Type | Individual
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Provider Name | COBY JORDON CUSHENBERY LMFT-T
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Gender | Male
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 7570 W 21ST ST N STE 1046A
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City | WICHITA
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State | KS
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Zip | 67205-1771
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Country | US
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Telephone | 316-749-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 N WOODLAND AVE
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City | WICHITA
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State | KS
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Zip | 67203-2737
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Country | US
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Telephone | 316-670-6556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 03409-T
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License Number State | KS
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