Doctor Name: | MR. KYLE COMBS |
NPI Number: | 1003240094 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1040 Waltham St Lexington, MA - 024218033 |
Business Phone Number: | 7742622868 |
Business Fax Number: | |
Mailing Address: | 1040 Waltham St, LEXINGTON |
State: | MA |
Postal Code: | 024218033 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/26/2013 |
NPI Last Update Date: | 08/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |