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General NPI Number Information
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NPI Number | 1265051726
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Entity Type | Individual
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Provider Name | MAE LYNN CORWIN
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 3425 13TH ST
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City | BAKER CITY
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State | OR
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Zip | 97814-1340
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Country | US
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Telephone | 541-523-7400
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Fax | 541-523-4927
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Provider Business Mailing Address
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Address Line | 3425 13TH ST
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City | BAKER CITY
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State | OR
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Zip | 97814-1340
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Country | US
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Telephone | 541-523-4000
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Fax | 541-523-4927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-20-168
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License Number State | OR
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