MEDICARE: CAROLYN MCCOMIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19764	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RENDERING NPI	OTHER	TX	1760563514

General Provider Information

NPI Number	:	1316246630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLYN MCCOMIS

Provider Business Mailing Address
First Line	:	101 S TRINITY ST
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-1819
Country	:	US
Telephone Number	:	940-627-1630
Fax Number	:	940-626-3741

Provider Business Practice Location Address
First Line	:	101 S TRINITY ST
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-1819
Country	:	US
Telephone Number	:	940-627-1630
Fax Number	:	940-626-3741

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	MRS. CAROLYN MCCOMIS
Credential	:	LPC
Telephone Number	:	940-627-1630

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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Directions to “CAROLYN MCCOMIS ” Practice Location

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