Provider Demographics
NPI:1851419006
Name:BAXTER, CORINNE YVONNE (LMFT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:YVONNE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2646
Mailing Address - Country:US
Mailing Address - Phone:805-217-3318
Mailing Address - Fax:805-653-5893
Practice Address - Street 1:2580 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2646
Practice Address - Country:US
Practice Address - Phone:805-217-3318
Practice Address - Fax:805-653-5893
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist