=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679624290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH KOBB LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21518 BLANCO RD STE 105
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78260-3380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-693-7838
-----------------------------------------------------
Fax | 210-892-3588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26331 DANCING BEAR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78260-5808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-693-7838
-----------------------------------------------------
Fax | 210-892-3588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 15981
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------