Provider Demographics
NPI:1417433681
Name:MCCOMAS, KARLY JO
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:JO
Last Name:MCCOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 SUTHERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4415
Mailing Address - Country:US
Mailing Address - Phone:916-893-8503
Mailing Address - Fax:
Practice Address - Street 1:9370 W STOCKTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8013
Practice Address - Country:US
Practice Address - Phone:209-667-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician