Provider Demographics
NPI:1669588364
Name:KURTH, CORINNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:
Last Name:KURTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30012 CANTOR CIR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4449
Mailing Address - Country:US
Mailing Address - Phone:210-643-3798
Mailing Address - Fax:
Practice Address - Street 1:31320 INTERSTATE 10 W STE A
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5028
Practice Address - Country:US
Practice Address - Phone:210-643-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164680401Medicaid