Provider Demographics
NPI:1558427872
Name:MCCOMBS, ERIN LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:MCCOMBS
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 1:1101 LAKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1046
Mailing Address - Country:US
Mailing Address - Phone:708-257-2838
Mailing Address - Fax:
Practice Address - Street 1:1101 LAKE ST STE 201
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1046
Practice Address - Country:US
Practice Address - Phone:708-257-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0100221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633662OtherBLUE CROSS PROVIDER #