MEDICARE: DENNIS L COBURN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2-1505	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598741662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS L COBURN PH.D.

Provider Business Mailing Address
First Line	:	4810 W PANTHER CREEK DR
Second Line	:	SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-5008
Country	:	US
Telephone Number	:	281-367-5664
Fax Number	:	281-292-4018

Provider Business Practice Location Address
First Line	:	1600 LAKE FRONT CIR
Second Line	:	SUITE 150
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3613
Country	:	US
Telephone Number	:	281-367-5664
Fax Number	:	281-292-4018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	05/02/2017

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