Provider Demographics
NPI:1003931205
Name:CORREIRA, KAY R (MA LMHC NCC)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:R
Last Name:CORREIRA
Suffix:
Gender:F
Credentials:MA LMHC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 N MAIN STREET
Mailing Address - Street 2:UNIT 12 BLDG 12 SUITE H
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530
Mailing Address - Country:US
Mailing Address - Phone:574-286-6172
Mailing Address - Fax:574-273-8743
Practice Address - Street 1:6910 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-286-6172
Practice Address - Fax:574-273-8743
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000392101YM0800X
VA0701002339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health