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General NPI Number Information
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NPI Number | 1679291058
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Entity Type | Individual
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Provider Name | CORINNE FORTH MS LMFT-ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 31320 INTERSTATE 10 W STE A
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City | BOERNE
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State | TX
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Zip | 78006-5028
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Country | US
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Telephone | 210-396-7609
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Fax | 830-755-2369
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Provider Business Mailing Address
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Address Line | 10538 BOUNTY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78245-1302
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Country | US
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Telephone | 916-425-9755
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 204717
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License Number State | TX
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