Provider Demographics
NPI:1275992604
Name:COREY, NICOLE M (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:COREY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12129 CHERRY GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3113
Mailing Address - Country:US
Mailing Address - Phone:058-889-9399
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD
Practice Address - Street 2:SUITE 521-24
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4016
Practice Address - Country:US
Practice Address - Phone:805-657-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist