Provider Demographics
NPI:1225338924
Name:CARSON, CORIE GAYLE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CORIE
Middle Name:GAYLE
Last Name:CARSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MISS
Other - First Name:CORIE
Other - Middle Name:GAYLE
Other - Last Name:RODEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:18932 MEADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9109
Mailing Address - Country:US
Mailing Address - Phone:331-998-5964
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:312-813-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000574106H00000X
IL166.001282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist