Provider Demographics
NPI:1184929507
Name:BARTHELL, CORINNE JILL (MFT)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:JILL
Last Name:BARTHELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22631 PACIFIC COAST HWY
Mailing Address - Street 2:#306
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5036
Mailing Address - Country:US
Mailing Address - Phone:310-589-1541
Mailing Address - Fax:310-589-1541
Practice Address - Street 1:22653 PACIFIC COAST HWY
Practice Address - Street 2:#10
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5096
Practice Address - Country:US
Practice Address - Phone:310-589-1541
Practice Address - Fax:310-589-1541
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist