Provider Demographics
NPI:1326499237
Name:HEATHER L. HOLCOMB, LSCSW, LLC
Entity Type:Organization
Organization Name:HEATHER L. HOLCOMB, LSCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-300-5787
Mailing Address - Street 1:8100 E 22ND ST N
Mailing Address - Street 2:BUILDING 100 SUITE 2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-300-5787
Mailing Address - Fax:316-337-5481
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:BUILDING 100 SUITE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-300-5787
Practice Address - Fax:316-337-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1205945474OtherINDIVIDUAL NPI NUMBER
KS070952OtherMEDICARE PTAN #
KS004186019Medicare PIN