Provider Demographics
NPI:1558858621
Name:MCCOMB, PHYLLIS (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 CORRICO CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2837
Mailing Address - Country:US
Mailing Address - Phone:719-345-2275
Mailing Address - Fax:
Practice Address - Street 1:300 GARDEN OF THE GODS RD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4248
Practice Address - Country:US
Practice Address - Phone:719-345-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health