Provider Demographics
NPI:1295426039
Name:SEYMOUR, CORINNE LYN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:LYN
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-0618
Mailing Address - Country:US
Mailing Address - Phone:408-657-6939
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 618
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-0618
Practice Address - Country:US
Practice Address - Phone:408-657-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist