Provider Demographics
NPI:1730545989
Name:CAYSON COMBS, DELMETRIA (LPCC)
Entity type:Individual
Prefix:
First Name:DELMETRIA
Middle Name:
Last Name:CAYSON COMBS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 TUNNEL HILL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-765-2335
Mailing Address - Fax:
Practice Address - Street 1:1374 BULL LEA ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511
Practice Address - Country:US
Practice Address - Phone:859-246-8644
Practice Address - Fax:859-233-9231
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172577101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100457270Medicaid