Provider Demographics
NPI:1871039255
Name:CORCORAN, KRISTINA MARIE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:OLTROGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1308 8TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2649
Mailing Address - Country:US
Mailing Address - Phone:515-689-4586
Mailing Address - Fax:515-598-7452
Practice Address - Street 1:1308 8TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2649
Practice Address - Country:US
Practice Address - Phone:708-536-3031
Practice Address - Fax:515-598-7452
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health