Provider Demographics
NPI:1285227736
Name:CORLEY, DENISE ELAINE (RBT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ELAINE
Last Name:CORLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ELAINE
Other - Last Name:BLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 N RICHARD JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-3664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 N RICHARD JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3664
Practice Address - Country:US
Practice Address - Phone:334-200-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-20-142270106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty