Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003240094 |
---|---|
Provider Name | Mr. Kyle Combs |
First Address | Lexington, MA 02421-8033 |
Second Address | Lexington, MA 02421-8033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000002352 | BMC (01) | MA |
042611055 | TAX ID (01) | MA |
1004745 | NHP (01) | MA |
1303287 | (05) | MA |
1303287 | MBHP (01) | MA |
99618201 | NETWORK HEALTH (01) | MA |
M18633 | BCBS (01) | MA |