Provider Demographics
NPI:1679617187
Name:HUNTSMAN, CORAL LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:CORAL
Middle Name:LYNN
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1123
Mailing Address - Country:US
Mailing Address - Phone:559-549-6697
Mailing Address - Fax:
Practice Address - Street 1:370 CRENSHAW BLVD
Practice Address - Street 2:STE E100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1727
Practice Address - Country:US
Practice Address - Phone:310-787-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50408106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist