MEDICARE: AUBREY LEAH CORONA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2018040874	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194204537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY LEAH CORONA LPC

Provider Business Mailing Address
First Line	:	529 SE 2ND ST STE D
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-2654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 SE 2ND ST # STREETD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-2694
Country	:	US
Telephone Number	:	816-581-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	11/19/2020

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