Provider Demographics
NPI:1710278866
Name:HOLCOMB, JEFFERY LEROY (LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:LEROY
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:L
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:33188 ELECTRIC BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1320
Mailing Address - Country:US
Mailing Address - Phone:440-933-8820
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD
Practice Address - Street 2:SUITE 265
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6318
Practice Address - Country:US
Practice Address - Phone:440-260-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600464101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor