Provider Demographics
NPI:1720476880
Name:COMLEY, KATRINA (MA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:COMLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42204-9024
Mailing Address - Country:US
Mailing Address - Phone:270-987-4456
Mailing Address - Fax:
Practice Address - Street 1:5345 RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:ALLENSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42204-9024
Practice Address - Country:US
Practice Address - Phone:270-987-4456
Practice Address - Fax:888-270-7319
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid