1952428021 NPI number — KEVIN G COMER LMSW

Table of content: KEVIN G COMER LMSW (NPI 1952428021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952428021 NPI number — KEVIN G COMER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMER
Provider First Name:
KEVIN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1952428021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 NE 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50144-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-446-2383
Provider Business Mailing Address Fax Number:
641-446-2382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W STATE ST
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH CENTERS OF SO IA - CORYDON
Provider Business Practice Location Address City Name:
CORYDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50060-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-872-1750
Provider Business Practice Location Address Fax Number:
641-872-1750
Provider Enumeration Date:
03/23/2007

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: 104100000X , with the licence number:  2235 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2235 . This is a "LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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