MEDICARE: MS. GAYLE ANN COBB L.P.C., N.C.C.

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	101YP2500X	Professional Counselor	6401006998	MI

General Provider Information

NPI Number	:	1770788762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAYLE ANN COBB L.P.C., N.C.C.

Provider Business Mailing Address
First Line	:	1205 S MISSION ST
Second Line	:	SUITE 7
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-3939
Country	:	US
Telephone Number	:	989-828-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 S MISSION ST
Second Line	:	SUITE 7
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-3939
Country	:	US
Telephone Number	:	989-828-4002
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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