Provider Demographics
NPI:1700045432
Name:OSBURN-CORCORAN, ALLISON DAWN
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DAWN
Last Name:OSBURN-CORCORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7704
Mailing Address - Country:US
Mailing Address - Phone:714-803-1031
Mailing Address - Fax:
Practice Address - Street 1:222 W MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7704
Practice Address - Country:US
Practice Address - Phone:714-803-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist