| Doctor Name: | MR. GARRETT LEE COBURN |
| NPI Number: | 1750528956 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | LCPC 3851 |
| Business Practice Address: | 13500 S. Pleasant Valley Rd Kuna, ID - 83634 |
| Business Phone Number: | 2083360740 |
| Business Fax Number: | |
| Mailing Address: | Po Box 14, KUNA |
| State: | ID |
| Postal Code: | 836340014 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2009 |
| NPI Last Update Date: | 11/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LCPC 3851 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |