Provider Demographics
NPI:1467462242
Name:CORN, GINGER GAYLE (MED,, LPC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:GAYLE
Last Name:CORN
Suffix:
Gender:F
Credentials:MED,, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN STE 262
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2194
Mailing Address - Country:US
Mailing Address - Phone:361-570-8900
Mailing Address - Fax:361-570-8903
Practice Address - Street 1:1501 E MOCKINGBIRD LN STE 262
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2194
Practice Address - Country:US
Practice Address - Phone:361-570-8900
Practice Address - Fax:361-570-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional