Provider Demographics
NPI:1730680174
Name:CORRO, KEYLA
Entity Type:Individual
Prefix:
First Name:KEYLA
Middle Name:
Last Name:CORRO
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 1:1024 W WOODLAWN AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5890
Mailing Address - Country:US
Mailing Address - Phone:956-844-3620
Mailing Address - Fax:
Practice Address - Street 1:5616 LONE STAR PKWY STE 101&102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2200
Practice Address - Country:US
Practice Address - Phone:210-202-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-22-59478103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst