Provider Demographics
NPI:1700806197
Name:MCOMBER, MARK BAIRD (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BAIRD
Last Name:MCOMBER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WOODWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1847
Mailing Address - Country:US
Mailing Address - Phone:559-297-6060
Mailing Address - Fax:559-297-6060
Practice Address - Street 1:3138 W BARSTOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2603
Practice Address - Country:US
Practice Address - Phone:559-770-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS148761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ021462ZMedicare ID - Type Unspecified