Provider Demographics
NPI:1518000322
Name:HOLCOMBE, CHRIS (MS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:HOLCOMBE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W SOUTHERN AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-7456
Mailing Address - Country:US
Mailing Address - Phone:480-982-1110
Mailing Address - Fax:
Practice Address - Street 1:1575 W SOUTHERN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-7456
Practice Address - Country:US
Practice Address - Phone:480-982-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ893174Medicaid