Provider Demographics
NPI:1134243447
Name:COMSTOCK, AMANDA (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 LURAY RD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:TN
Mailing Address - Zip Code:38345-9601
Mailing Address - Country:US
Mailing Address - Phone:731-968-8059
Mailing Address - Fax:
Practice Address - Street 1:233 OIL WELL RD STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8014
Practice Address - Country:US
Practice Address - Phone:731-660-8467
Practice Address - Fax:731-660-8495
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health