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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972690303 NPPES
Texas MEDICAID 028530601

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