Healthcare Provider Details

I. General information

NPI: 1477377224
Provider Name (Legal Business Name): TYLER ANDREW CORBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 TEAYS VALLEY RD
HURRICANE WV
25526-0319
US

IV. Provider business mailing address

1727 CRESTMONT DR
HUNTINGTON WV
25701-5312
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-1055
  • Fax:
Mailing address:
  • Phone: 304-993-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBP00946780
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00946780
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: