MEDICARE: ABBY GINA CORAM MA

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	101Y00000X	Counselor
2	101Y00000X	Counselor		CO

General Provider Information

NPI Number	:	1528338373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY GINA CORAM MA

Provider Business Mailing Address
First Line	:	1141 GLENGARY PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-6604
Country	:	US
Telephone Number	:	719-761-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 GLENGARY PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-6604
Country	:	US
Telephone Number	:	719-761-3710
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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