Provider Demographics
NPI:1801116173
Name:COMBS, ELIZABETH SUZANNE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUZANNE
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1070 LORIEN CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8987
Mailing Address - Country:US
Mailing Address - Phone:270-401-1410
Mailing Address - Fax:
Practice Address - Street 1:110 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2423
Practice Address - Country:US
Practice Address - Phone:270-763-0728
Practice Address - Fax:270-422-4882
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist