Provider Demographics
NPI:1568778231
Name:LIBBY, CORINNE G (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:G
Last Name:LIBBY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:G
Other - Last Name:MORTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:2705 BUNKER LAKE BLVD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3784
Mailing Address - Country:US
Mailing Address - Phone:763-754-0903
Mailing Address - Fax:612-235-6447
Practice Address - Street 1:1875 STATION PKWY NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3319
Practice Address - Country:US
Practice Address - Phone:763-754-0903
Practice Address - Fax:612-235-6447
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist