Provider Demographics
NPI:1447567052
Name:CORBIN, JASON LANE
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LANE
Last Name:CORBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 196TH ST SW STE 220
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6409
Mailing Address - Country:US
Mailing Address - Phone:425-835-5850
Mailing Address - Fax:
Practice Address - Street 1:4807 196TH ST SW STE 220
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6409
Practice Address - Country:US
Practice Address - Phone:425-835-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health