Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103K00000X | Behavior Analyst | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 122300000X | Dentist | 018002187 | IL |
Y | 1223G0001X | General Practice | 018002187 | IL |
Y | 213EG0000X | General Practice | 018002187 | IL |
NPI | 1811565146 |
---|---|
Provider Name | Kyla Combs |
First Address | Oklahoma City, OK 73120-5013 |
Second Address | Oklahoma City, OK 73120-5013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2021 |
Last Update Date | 14/06/2021 |