Healthcare Provider Details

I. General information

NPI: 1386973758
Provider Name (Legal Business Name): GEORGE E COMISKEY LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 50TH ST SUITE 509
LUBBOCK TX
79414-3521
US

IV. Provider business mailing address

4630 50TH ST SUITE 509
LUBBOCK TX
79414-3521
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-8808
  • Fax: 806-771-8809
Mailing address:
  • Phone: 806-771-8808
  • Fax: 806-771-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: