Provider Demographics
NPI:1316246630
Name:CAROLYN MCCOMIS
Entity type:Organization
Organization Name:CAROLYN MCCOMIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:940-627-1630
Mailing Address - Street 1:101 S TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1819
Mailing Address - Country:US
Mailing Address - Phone:940-627-1630
Mailing Address - Fax:940-626-3741
Practice Address - Street 1:101 S TRINITY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1819
Practice Address - Country:US
Practice Address - Phone:940-627-1630
Practice Address - Fax:940-626-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175788201Medicaid
TXRENDERING NPIOther1760563514