MEDICARE: MR. GREGORY S CORBIN MFT

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	106H00000X	Marriage & Family Therapist	MFC39352	CA

General Provider Information

NPI Number	:	1255769022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY S CORBIN MFT

Provider Business Mailing Address
First Line	:	3424 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1557
Country	:	US
Telephone Number	:	562-631-7938
Fax Number	:	714-828-1868

Provider Business Practice Location Address
First Line	:	3424 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1557
Country	:	US
Telephone Number	:	562-631-7938
Fax Number	:	714-828-1868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	10/14/2013

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