Healthcare Provider Details

I. General information

NPI: 1255769022
Provider Name (Legal Business Name): GREGORY S CORBIN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 E 4TH ST
LONG BEACH CA
90814-1557
US

IV. Provider business mailing address

3424 E 4TH ST
LONG BEACH CA
90814-1557
US

V. Phone/Fax

Practice location:
  • Phone: 562-631-7938
  • Fax: 714-828-1868
Mailing address:
  • Phone: 562-631-7938
  • Fax: 714-828-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: