Provider Demographics
NPI:1952428021
Name:COMER, KEVIN G (LMSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:COMER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144-1206
Mailing Address - Country:US
Mailing Address - Phone:641-446-2383
Mailing Address - Fax:641-446-2382
Practice Address - Street 1:215 W STATE ST
Practice Address - Street 2:BEHAVIORAL HEALTH CENTERS OF SO IA - CORYDON
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-9998
Practice Address - Country:US
Practice Address - Phone:641-872-1750
Practice Address - Fax:641-872-1750
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2235OtherLICENSE
IA2235OtherLICENSE