Provider Demographics
NPI:1356829360
Name:MCEACHRON, CORALIE SHAWN (LMFT)
Entity Type:Individual
Prefix:
First Name:CORALIE
Middle Name:SHAWN
Last Name:MCEACHRON
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 1:528 WOODED FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2199
Mailing Address - Country:US
Mailing Address - Phone:502-509-2576
Mailing Address - Fax:502-709-5117
Practice Address - Street 1:528 WOODED FALLS RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2199
Practice Address - Country:US
Practice Address - Phone:502-509-2576
Practice Address - Fax:502-709-5117
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246482106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist