Provider Demographics
NPI:1689279937
Name:MCCUNE, CORRIE JEAN
Entity Type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:JEAN
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CORRIE
Other - Middle Name:J
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2155 E GARVEY AVE N STE B17
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1545
Mailing Address - Country:US
Mailing Address - Phone:626-489-9144
Mailing Address - Fax:
Practice Address - Street 1:2155 E GARVEY AVE N STE B17
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1545
Practice Address - Country:US
Practice Address - Phone:626-489-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist