Provider Demographics
NPI:1871851170
Name:COMBS, DENNIS ROYNALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROYNALD
Last Name:COMBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:ROYNALD
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-0744
Mailing Address - Country:US
Mailing Address - Phone:903-316-2280
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY BLVD
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY, UT TYLER
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75799
Practice Address - Country:US
Practice Address - Phone:903-565-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical