Healthcare Provider Details

I. General information

NPI: 1063647162
Provider Name (Legal Business Name): MISTY RENEE' COMER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WEDDINGTON BRANCH RD
PIKEVILLE KY
41501-3204
US

IV. Provider business mailing address

PO BOX 1429
MT WASHINGTON KY
40047-1429
US

V. Phone/Fax

Practice location:
  • Phone: 606-437-9500
  • Fax: 606-437-0940
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1505
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: