Provider Demographics
NPI:1760563514
Name:MCCOMIS, CAROLYN K (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:K
Last Name:MCCOMIS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1819
Mailing Address - Country:US
Mailing Address - Phone:940-627-1630
Mailing Address - Fax:940-626-3741
Practice Address - Street 1:101 S TRINITY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1819
Practice Address - Country:US
Practice Address - Phone:940-627-1630
Practice Address - Fax:940-626-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175788201Medicaid
TX84788LOtherBCBS PROVIDER NUMBER
TX10035138OtherAMERIGROUP PROV. NUMBER