Healthcare Provider Details

I. General information

NPI: 1538398979
Provider Name (Legal Business Name): LAURI CHRISTINE COMBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR
LA MESA CA
91942-3017
US

IV. Provider business mailing address

1245 SHARON WAY
RENO NV
89509-2550
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2383
  • Fax:
Mailing address:
  • Phone: 775-527-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6202-C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: