Healthcare Provider Details

I. General information

NPI: 1619211844
Provider Name (Legal Business Name): LISA M. CORBETT MSC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 12/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 E BEHREND DRIVE
PHOENIX AZ
85050-9568
US

IV. Provider business mailing address

3218 E BELL ROAD, #2124
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-5259
  • Fax: 602-997-1305
Mailing address:
  • Phone: 602-370-2669
  • Fax: 602-997-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: