Provider Demographics
NPI:1316763030
Name:LACOMBE, KATRINA (MA, LPC, ATR)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LACOMBE
Suffix:
Gender:X
Credentials:MA, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6478 SCANLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2402
Mailing Address - Country:US
Mailing Address - Phone:816-877-6590
Mailing Address - Fax:
Practice Address - Street 1:6478 SCANLAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2402
Practice Address - Country:US
Practice Address - Phone:816-877-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22-215221700000X
MO2020032634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist