Provider Demographics
NPI:1689499535
Name:COBY BRYAN LCSW LLC
Entity type:Organization
Organization Name:COBY BRYAN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:COBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-751-4789
Mailing Address - Street 1:2869 PARROTT AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1020
Mailing Address - Country:US
Mailing Address - Phone:678-751-4789
Mailing Address - Fax:
Practice Address - Street 1:2869 PARROTT AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1020
Practice Address - Country:US
Practice Address - Phone:678-751-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health