Provider Demographics
NPI:1326314451
Name:CORBIN, FAWN LEE (LPC)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:LEE
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3911
Mailing Address - Country:US
Mailing Address - Phone:970-266-5372
Mailing Address - Fax:970-226-2613
Practice Address - Street 1:301 SKYWAY DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3911
Practice Address - Country:US
Practice Address - Phone:970-266-5372
Practice Address - Fax:970-226-2613
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-5866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health