Provider Demographics
NPI:1578953592
Name:MCCORKLE, MICHON (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHON
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 3RD AVE SW STE 107
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7542
Mailing Address - Country:US
Mailing Address - Phone:317-669-2279
Mailing Address - Fax:704-220-2256
Practice Address - Street 1:1010 3RD AVE SW STE 107
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7542
Practice Address - Country:US
Practice Address - Phone:317-669-2279
Practice Address - Fax:704-840-6555
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10034A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist