Provider Demographics
NPI:1215213962
Name:KOMAR, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:KOMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE # 226
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3023
Mailing Address - Country:US
Mailing Address - Phone:480-655-7933
Mailing Address - Fax:480-649-1298
Practice Address - Street 1:1839 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE # 226
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3023
Practice Address - Country:US
Practice Address - Phone:480-655-7933
Practice Address - Fax:480-649-1298
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health