Provider Demographics
NPI:1356515050
Name:BARB CORBETT, LLC
Entity type:Organization
Organization Name:BARB CORBETT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP, LMSW
Authorized Official - Phone:517-437-5538
Mailing Address - Street 1:55 BARRY ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1809
Mailing Address - Country:US
Mailing Address - Phone:517-437-5538
Mailing Address - Fax:517-427-5538
Practice Address - Street 1:55 BARRY ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1809
Practice Address - Country:US
Practice Address - Phone:517-437-5538
Practice Address - Fax:517-427-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005635103TC0700X
MI68010637481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid
MI=========Medicaid