Provider Demographics
NPI:1316022338
Name:COMENSKY, MARK H (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:COMENSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2202
Mailing Address - Country:US
Mailing Address - Phone:417-667-4230
Mailing Address - Fax:417-667-7607
Practice Address - Street 1:300 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2202
Practice Address - Country:US
Practice Address - Phone:417-667-4230
Practice Address - Fax:417-667-7607
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000575101YM0800X
KS1297103TC0700X
MOR0443103TC1900X
MO300007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493212757Medicaid
MO493212732Medicaid
KS4985848601Medicaid
MO493212740Medicaid
MO493212740Medicaid