Healthcare Provider Details

I. General information

NPI: 1700045432
Provider Name (Legal Business Name): ALLISON DAWN OSBURN-CORCORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MAIN ST STE 203
TUSTIN CA
92780-7704
US

IV. Provider business mailing address

222 W MAIN ST STE 203
TUSTIN CA
92780-7704
US

V. Phone/Fax

Practice location:
  • Phone: 714-803-1031
  • Fax:
Mailing address:
  • Phone: 714-803-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT52602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: