1689173825 NPI number — JEFFREY COMBS LPCC

Table of content: JEFFREY COMBS LPCC (NPI 1689173825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689173825 NPI number — JEFFREY COMBS LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMBS
Provider First Name:
JEFFREY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689173825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1192 PIGEONROOST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BULAN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41722-9027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-216-5431
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CLYDEAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBURN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41831-8702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-1148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 175315 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)