Provider Demographics
NPI:1194204537
Name:CORONA, AUBREY LEAH (LPC)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:LEAH
Last Name:CORONA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:LEAH
Other - Last Name:RUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 SE 2ND ST STE D
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 SE 2ND ST # STREETD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2694
Practice Address - Country:US
Practice Address - Phone:816-581-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018040874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490063179Medicaid