Provider Demographics
NPI:1346426343
Name:COMLEY, LINDA SUE (MED)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:COMLEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 FOUR MILE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9229
Mailing Address - Country:US
Mailing Address - Phone:859-624-3716
Mailing Address - Fax:859-624-3716
Practice Address - Street 1:1582 FOUR MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9229
Practice Address - Country:US
Practice Address - Phone:859-624-3716
Practice Address - Fax:859-624-3716
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNO LICENSE NUMBER103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool