Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 76882 | TX |
NPI | 1003378266 |
---|---|
Provider Name | Joan Patricia Deming-Combs |
First Address | San Angelo, TX 76904-5932 |
Second Address | San Angelo, TX 76904-5932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2019 |
Last Update Date | 04/04/2019 |