=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679807291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSBY & COSBY COUNSELING & CONSULTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2009
-----------------------------------------------------
Last Update Date | 04/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 W BYPASS
-----------------------------------------------------
City | ANDALUSIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36420-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-582-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 W BYPASS
-----------------------------------------------------
City | ANDALUSIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36420-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-222-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. EMMA STACY COSBY
-----------------------------------------------------
Credential | LCSW, PIP
-----------------------------------------------------
Telephone | 334-892-3252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1384C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 591
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------