Provider Demographics
NPI:1255798401
Name:T.R. LISCOMBE FAMILY AND BEHAVIORAL CONSULTANTS, LLC
Entity type:Organization
Organization Name:T.R. LISCOMBE FAMILY AND BEHAVIORAL CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC NCC
Authorized Official - Phone:248-445-0882
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48332-0563
Mailing Address - Country:US
Mailing Address - Phone:248-445-0882
Mailing Address - Fax:
Practice Address - Street 1:7310 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3165
Practice Address - Country:US
Practice Address - Phone:248-445-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health