Provider Demographics
NPI:1457838542
Name:BIDDLE, KOMEKA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KOMEKA
Middle Name:
Last Name:BIDDLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S STONEBRIDGE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8023
Mailing Address - Country:US
Mailing Address - Phone:469-440-8856
Mailing Address - Fax:469-625-2540
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 203
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8023
Practice Address - Country:US
Practice Address - Phone:469-440-8856
Practice Address - Fax:469-625-2540
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72024101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty