Provider Demographics
NPI:1528607058
Name:COMBS-YOWELL, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COMBS-YOWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PLEASANT VIEW CT
Mailing Address - Street 2:
Mailing Address - City:GIFFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61847-9767
Mailing Address - Country:US
Mailing Address - Phone:217-714-4388
Mailing Address - Fax:
Practice Address - Street 1:103 PLEASANT VIEW CT
Practice Address - Street 2:
Practice Address - City:GIFFORD
Practice Address - State:IL
Practice Address - Zip Code:61847-9767
Practice Address - Country:US
Practice Address - Phone:217-714-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0129901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical