Provider Demographics
NPI:1891329918
Name:COBALT, TEVIN MCDONALD (LCSW)
Entity type:Individual
Prefix:
First Name:TEVIN
Middle Name:MCDONALD
Last Name:COBALT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21311 MOUNT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6532
Mailing Address - Country:US
Mailing Address - Phone:301-357-1077
Mailing Address - Fax:
Practice Address - Street 1:21311 MOUNT VIEW DR
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-6532
Practice Address - Country:US
Practice Address - Phone:301-357-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083203104100000X
DCLC2000023401041C0700X
TX1136541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker