Healthcare Provider Details

I. General information

NPI: 1275029373
Provider Name (Legal Business Name): RAY COMBS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD
AUSTIN TX
78759-8661
US

IV. Provider business mailing address

PO BOX 550769
HOUSTON TX
77255-0769
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 713-686-9194
  • Fax: 713-686-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: