Provider Demographics
NPI:1144763442
Name:CORONA, ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 DORTMUNDER DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-4853
Mailing Address - Country:US
Mailing Address - Phone:775-241-8845
Mailing Address - Fax:
Practice Address - Street 1:1055 ROBERTA LN STE 102B
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2821
Practice Address - Country:US
Practice Address - Phone:775-241-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist