MEDICARE: CANOPY COLLABORATIVE PROFESSIONAL CLINICAL COUNSELOR, P.C.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427905777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANOPY COLLABORATIVE PROFESSIONAL CLINICAL COUNSELOR, P.C.

Provider Business Mailing Address
First Line	:	4370 TUJUNGA AVE STE 210
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2763
Country	:	US
Telephone Number	:	424-231-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 TUJUNGA AVE STE 210
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2763
Country	:	US
Telephone Number	:	424-231-4450
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SECRETARY
Name	:	CORBETT HANCOCK MILLER
Credential	:	LCSW
Telephone Number	:	213-880-5428

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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