Provider Demographics
NPI:1386634509
Name:IRELAN, CORBIN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORBIN
Middle Name:S
Last Name:IRELAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MICHIGAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1432
Mailing Address - Country:US
Mailing Address - Phone:269-657-6025
Mailing Address - Fax:269-657-5198
Practice Address - Street 1:181 W MICHIGAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1432
Practice Address - Country:US
Practice Address - Phone:269-657-6025
Practice Address - Fax:269-657-5198
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical