Provider Demographics
NPI:1790029783
Name:BAYER, CORISSA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORISSA
Middle Name:LYNN
Last Name:BAYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CORISSA
Other - Middle Name:LYNN
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3 VINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5069
Mailing Address - Country:US
Mailing Address - Phone:850-226-7666
Mailing Address - Fax:850-226-7499
Practice Address - Street 1:3 VINE AVE NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5069
Practice Address - Country:US
Practice Address - Phone:850-226-7666
Practice Address - Fax:850-226-7499
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3571103TC0700X
FLPY9441103TC0700X
FLPY9440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical