Healthcare Provider Details

I. General information

NPI: 1336434695
Provider Name (Legal Business Name): LINDSEY JENIFER KORBITZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E 3RD ST
LA JUNTA CO
81050-2005
US

IV. Provider business mailing address

1420 E 3RD ST
LA JUNTA CO
81050-2005
US

V. Phone/Fax

Practice location:
  • Phone: 719-980-1195
  • Fax:
Mailing address:
  • Phone: 719-980-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5956
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: