Provider Demographics
NPI:1679576532
Name:COBURN, WILLIAM RICHARD (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:COBURN
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAIN ST
Mailing Address - Street 2:STE 708
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2726
Mailing Address - Country:US
Mailing Address - Phone:304-232-7232
Mailing Address - Fax:304-232-7245
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:STE 708
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2726
Practice Address - Country:US
Practice Address - Phone:304-232-7232
Practice Address - Fax:304-232-7245
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1683101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
CP01262Medicare ID - Type Unspecified