Cockburn, Jack Taylor
Cockburn, Jack Taylor is an sole proprietor health care provider with primary practice located at 131 Degan #103, Lewisville TX 75057. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Counseling. Behavioral Health & Social Service Providers / Counseling is his primary health care specialty. Cockburn, Jack Taylor can be contacted via phone (972) 436-8881.Contact Information
Primary practice address
131 Degan #103
Lewisville TX 75057
Phone: (972) 436-8881
Fax: (972) 355-7934
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 14096 | Texas |
| Behavioral Health & Social Service Providers / Counseling | 103TC1900X | 14096 | Texas |
Profile Details
| NPI number | 1972690303 |
|---|---|
| LBN Legal business name | Cockburn, Jack Taylor |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 6th, 2006 |
| Last updated | Aug 26th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972690303 | NPPES |
| Texas | MEDICAID | 028530601 |
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