Healthcare Provider Details

I. General information

NPI: 1104941830
Provider Name (Legal Business Name): MARK DAVID MCOMBER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 WOODWORTH AVE
CLOVIS CA
93612-1847
US

IV. Provider business mailing address

624 WOODWORTH AVE
CLOVIS CA
93612-1847
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-6060
  • Fax:
Mailing address:
  • Phone: 559-297-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 26149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: