Provider Demographics
NPI:1750668489
Name:COMBS, KATHERINE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5114
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5114
Mailing Address - Country:US
Mailing Address - Phone:423-433-7951
Mailing Address - Fax:423-370-1778
Practice Address - Street 1:4100 N ROAN ST STE 214
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1103
Practice Address - Country:US
Practice Address - Phone:423-797-6284
Practice Address - Fax:423-370-1778
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3527101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ016901Medicaid