Healthcare Provider Details

I. General information

NPI: 1720399413
Provider Name (Legal Business Name): BARBARA M CORKREAN LPC, CADCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16239 SE MCLOUGHLIN BLVD STE 208
MILWAUKIE OR
97267-4654
US

IV. Provider business mailing address

PO BOX 82819
PORTLAND OR
97282-0819
US

V. Phone/Fax

Practice location:
  • Phone: 971-206-4776
  • Fax:
Mailing address:
  • Phone: 503-233-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3039
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: