Healthcare Provider Details

I. General information

NPI: 1164334264
Provider Name (Legal Business Name): EMILY CORNEA LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY BRENDER

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 W CLARKSTON RD
LAKE ORION MI
48362-2892
US

IV. Provider business mailing address

546 PINE ST
LAPEER MI
48446-2169
US

V. Phone/Fax

Practice location:
  • Phone: 844-642-9273
  • Fax:
Mailing address:
  • Phone: 810-569-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: