Provider Demographics
NPI:1386153658
Name:KOBOLD, DAVID ELMER (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ELMER
Last Name:KOBOLD
Suffix:
Gender:M
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 GRAND AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2762
Mailing Address - Country:US
Mailing Address - Phone:406-591-0094
Mailing Address - Fax:
Practice Address - Street 1:1925 GRAND AVE STE 121
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2762
Practice Address - Country:US
Practice Address - Phone:406-591-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-25665101YA0400X
MT590431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1386153658Medicaid