MEDICARE: CORRIN CRAIN LMFT #113622

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	106H00000X	Marriage & Family Therapist	113622	CA

General Provider Information

NPI Number	:	1972162329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORRIN CRAIN LMFT #113622

Provider Business Mailing Address
First Line	:	2635 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3728
Country	:	US
Telephone Number	:	858-727-8498
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	11/29/2023

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