Healthcare Provider Details

I. General information

NPI: 1609696764
Provider Name (Legal Business Name): KORBY CALLEY MA, MFT-I, LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 IAO VALLEY RD APT A
WAILUKU HI
96793-3013
US

IV. Provider business mailing address

3600 COLLEGE AVE
SNYDER TX
79549-4637
US

V. Phone/Fax

Practice location:
  • Phone: 512-484-4379
  • Fax:
Mailing address:
  • Phone: 512-484-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number95966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: