Provider Demographics
NPI:1912214248
Name:CORBETT, JOHN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CORBETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18517 CHARLA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-9798
Mailing Address - Country:US
Mailing Address - Phone:816-309-4344
Mailing Address - Fax:
Practice Address - Street 1:18517 CHARLA DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9798
Practice Address - Country:US
Practice Address - Phone:816-309-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional