Healthcare Provider Details

I. General information

NPI: 1346426343
Provider Name (Legal Business Name): LINDA SUE COMLEY M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 FOUR MILE RD
RICHMOND KY
40475-9229
US

IV. Provider business mailing address

1582 FOUR MILE RD
RICHMOND KY
40475-9229
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-3716
  • Fax: 859-624-3716
Mailing address:
  • Phone: 859-624-3716
  • Fax: 859-624-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberNO LICENSE NUMBER
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: