Provider Demographics
NPI:1588710131
Name:LACOMBE, JO ANNE S (LICENSED MFT)
Entity type:Individual
Prefix:MS
First Name:JO ANNE
Middle Name:S
Last Name:LACOMBE
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:MRS
Other - First Name:JO ANNE
Other - Middle Name:S
Other - Last Name:KILLILEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED MFT
Mailing Address - Street 1:1738 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4441
Mailing Address - Country:US
Mailing Address - Phone:415-705-0994
Mailing Address - Fax:415-751-1483
Practice Address - Street 1:1738 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4441
Practice Address - Country:US
Practice Address - Phone:415-705-0994
Practice Address - Fax:415-751-1483
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist