MEDICARE: CAROLYN K MCCOMIS MED., LPC

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	84788L	OTHER	TX	BCBS PROVIDER NUMBER
3	10035138	OTHER	TX	AMERIGROUP PROV. NUMBER

General Provider Information

NPI Number	:	1760563514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN K MCCOMIS MED., LPC

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/25/2011

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