Provider Demographics
NPI:1407748312
Name:MCCOMAS, MACKENZIE ELEANOR
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ELEANOR
Last Name:MCCOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4165
Mailing Address - Country:US
Mailing Address - Phone:985-331-1999
Mailing Address - Fax:
Practice Address - Street 1:13101 RIVER RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4165
Practice Address - Country:US
Practice Address - Phone:985-331-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10228101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor