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General NPI Number Information
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NPI Number | 1316479215
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Entity Type | Organization
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Legal Business Name | COREY COUNSELING LLC
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 4400 BAYOU BLVD UNIT 47-C3
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City | PENSACOLA
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State | FL
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Zip | 32503-2673
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Country | US
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Telephone | 850-530-2960
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Fax |
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Provider Business Mailing Address
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Address Line | 408 ROSSI WAY
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City | PENSACOLA
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State | FL
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Zip | 32506-5536
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Country | US
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Telephone | 850-530-2960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN COREY
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Credential |
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Telephone | 850-530-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | IMH15424
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License Number State | FL
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