Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 23823 | IL |
NPI | 1003104472 |
---|---|
Provider Name | Herbert T Cobbs |
First Address | Chicago, IL 60640-4689 |
Second Address | Chicago, IL 60640-4689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 19/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1616824 | BLUE SHIELD (01) | IL |