Healthcare Provider Details

I. General information

NPI: 1023316809
Provider Name (Legal Business Name): IRENE CORZO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CHURCH ST STE 206
EAST TROY WI
53120-1304
US

IV. Provider business mailing address

PO BOX 2044
MCHENRY IL
60051-9034
US

V. Phone/Fax

Practice location:
  • Phone: 262-374-4970
  • Fax: 262-342-2949
Mailing address:
  • Phone: 262-374-4970
  • Fax: 262-342-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180007190
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: