Provider Demographics
NPI:1316001894
Name:MCCOMB, PATRICIA LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N WILMOT RD STE A200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4416
Mailing Address - Country:US
Mailing Address - Phone:520-873-8562
Mailing Address - Fax:888-851-7021
Practice Address - Street 1:1500 N WILMOT RD STE A200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4416
Practice Address - Country:US
Practice Address - Phone:520-873-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS227701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1508AOtherTEMPLETON PTAN GROUP
CAW1508COtherATASCADERO PTAN GROUP
CAW1508EOtherSAN LUISOBISPO PTAN
CA551983OtherMEDICARE SAN LUIS OBISPO
CAW1508OtherCAMBRIA PTAN GROUP
CA551978OtherMEDICARE-ATASCADERO
CO551907OtherMEDICARE-TEMPLETON
CAHAP71031FOtherFAMILY PACT
CA051064OtherMEDICARE-CAMBRIA
CAFHC 71031FMedicaid