Provider Demographics
NPI:1801157599
Name:COMBS, KATIE BUNDREN (LPC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:BUNDREN
Last Name:COMBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BUNDREN LN
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-6227
Mailing Address - Country:US
Mailing Address - Phone:423-526-8440
Mailing Address - Fax:
Practice Address - Street 1:207 BUNDREN LN
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-6227
Practice Address - Country:US
Practice Address - Phone:423-526-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TN3268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor