Provider Demographics
NPI:1144340290
Name:DENNIS L. COBURN, PH.D. & ASSOCIATES
Entity type:Organization
Organization Name:DENNIS L. COBURN, PH.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (PSYCHOLOGIST)
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-367-5664
Mailing Address - Street 1:PO BOX 7338
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-7338
Mailing Address - Country:US
Mailing Address - Phone:281-367-5664
Mailing Address - Fax:281-292-4018
Practice Address - Street 1:4810 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-5008
Practice Address - Country:US
Practice Address - Phone:281-367-5664
Practice Address - Fax:281-292-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0327546-01Medicaid
TX0327546-01Medicaid