Provider Demographics
NPI:1659045854
Name:MILBURN, COREY ALLEN (BS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ALLEN
Last Name:MILBURN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 CRESCENT ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3303
Mailing Address - Country:US
Mailing Address - Phone:269-567-8588
Mailing Address - Fax:
Practice Address - Street 1:10327 GRAND RIVER RD STE 401
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6501
Practice Address - Country:US
Practice Address - Phone:269-567-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician