Healthcare Provider Details

I. General information

NPI: 1194655274
Provider Name (Legal Business Name): TREVOR MCCORKLE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E WASHINGTON BLVD
FORT WAYNE IN
46802-3210
US

IV. Provider business mailing address

2700 LAFAYETTE ST STE 110
FORT WAYNE IN
46806-1100
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-0780
  • Fax: 260-266-0785
Mailing address:
  • Phone: 260-266-0780
  • Fax: 260-266-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006047A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: