Provider Demographics
NPI:1043570096
Name:CORIELL, THERESA (LPCC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CORIELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S COURT ST
Mailing Address - Street 2:5
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2275
Mailing Address - Country:US
Mailing Address - Phone:330-723-7977
Mailing Address - Fax:
Practice Address - Street 1:230 S COURT ST
Practice Address - Street 2:5
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2275
Practice Address - Country:US
Practice Address - Phone:330-723-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health