Provider Demographics
NPI:1558409136
Name:CORYELL, CAROLE ANNE (MS , PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANNE
Last Name:CORYELL
Suffix:
Gender:F
Credentials:MS , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 NW VILLAGE PARK DR
Mailing Address - Street 2:G-240
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-7875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1715 114TH AVE SE
Practice Address - Street 2:SUITE 208
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6945
Practice Address - Country:US
Practice Address - Phone:425-260-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist