Provider Demographics
NPI:1053485151
Name:CORLEY, DANIEL CHARLES (PHD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CHARLES
Last Name:CORLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4425
Mailing Address - Country:US
Mailing Address - Phone:972-542-2779
Mailing Address - Fax:972-542-2313
Practice Address - Street 1:200 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4425
Practice Address - Country:US
Practice Address - Phone:972-542-2779
Practice Address - Fax:972-542-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81565PMedicare ID - Type Unspecified