Healthcare Provider Details

I. General information

NPI: 1528305885
Provider Name (Legal Business Name): CORI A URAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CAROLDEAN CT
HALTOM CITY TX
76117-1201
US

IV. Provider business mailing address

5000 CAROLDEAN CT
HALTOM CITY TX
76117-1201
US

V. Phone/Fax

Practice location:
  • Phone: 817-896-3174
  • Fax:
Mailing address:
  • Phone: 817-896-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: