Provider Demographics
NPI:1003966573
Name:COMBS, CHARLES (MED)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:COMBS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TIMBERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-8578
Mailing Address - Country:US
Mailing Address - Phone:940-391-2158
Mailing Address - Fax:
Practice Address - Street 1:207 W HICKORY ST
Practice Address - Street 2:#306
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4156
Practice Address - Country:US
Practice Address - Phone:940-565-1818
Practice Address - Fax:940-387-8378
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6403101YP2500X
TX113781041C0700X
TX1370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist