Provider Demographics
NPI:1013541879
Name:COMBEST, BREANNA BETH (LLMSW)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:BETH
Last Name:COMBEST
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N KALAMAZOO MALL STE 100
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3882
Mailing Address - Country:US
Mailing Address - Phone:269-345-0273
Mailing Address - Fax:
Practice Address - Street 1:222 N KALAMAZOO MALL STE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3882
Practice Address - Country:US
Practice Address - Phone:269-345-0273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801101803104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker