Healthcare Provider Details

I. General information

NPI: 1952270845
Provider Name (Legal Business Name): MR. HENRY BRIMAGE COMBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CORTE MESA DR
SAN RAFAEL CA
94901-1301
US

IV. Provider business mailing address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

V. Phone/Fax

Practice location:
  • Phone: 720-592-9524
  • Fax:
Mailing address:
  • Phone: 720-592-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number261QM28--X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: