Provider Demographics
NPI:1154633238
Name:NANCY MATTER COBB. LCSW, INC.
Entity type:Organization
Organization Name:NANCY MATTER COBB. LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MATTER
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-415-2305
Mailing Address - Street 1:717 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6030
Mailing Address - Country:US
Mailing Address - Phone:405-415-2305
Mailing Address - Fax:405-415-2301
Practice Address - Street 1:717 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6030
Practice Address - Country:US
Practice Address - Phone:405-415-2305
Practice Address - Fax:405-415-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244414801Medicare PIN