Provider Demographics
NPI:1982821583
Name:HART, CORINE GAIL (LMFT)
Entity Type:Individual
Prefix:
First Name:CORINE
Middle Name:GAIL
Last Name:HART
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 1:629 DEL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5318
Mailing Address - Country:US
Mailing Address - Phone:559-355-8030
Mailing Address - Fax:
Practice Address - Street 1:629 DEL MONTE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5318
Practice Address - Country:US
Practice Address - Phone:559-355-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF45677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA160101904300Medicaid