Healthcare Provider Details

I. General information

NPI: 1992484364
Provider Name (Legal Business Name): CORBIN LEE HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W NORTH ST UNIT A
GREENFIELD IN
46140-2171
US

IV. Provider business mailing address

8157 BEARBERRY LN
PENDLETON IN
46064-6461
US

V. Phone/Fax

Practice location:
  • Phone: 317-483-7057
  • Fax: 317-981-1741
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99136700A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: