Provider Demographics
NPI:1417901380
Name:CORLEY, DONALD L (DR)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:CORLEY
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 OLD MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6495
Mailing Address - Country:US
Mailing Address - Phone:254-751-1550
Mailing Address - Fax:254-751-9291
Practice Address - Street 1:8401 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6495
Practice Address - Country:US
Practice Address - Phone:254-751-1550
Practice Address - Fax:254-751-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00A72LMedicare ID - Type UnspecifiedMEDICARE
TXR56235Medicare UPIN