Provider Demographics
NPI:1245896349
Name:CORPS, KIT J (MA, LMHCA)
Entity type:Individual
Prefix:MISS
First Name:KIT
Middle Name:J
Last Name:CORPS
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 ENGLE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2209
Mailing Address - Country:US
Mailing Address - Phone:260-483-2400
Mailing Address - Fax:260-960-9361
Practice Address - Street 1:7230 ENGLE RD STE 304
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2209
Practice Address - Country:US
Practice Address - Phone:260-483-2400
Practice Address - Fax:260-960-9361
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000634A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health