Provider Demographics
NPI:1720516768
Name:DAVIS-LOBBAN, KORINNE ELON (LMFT)
Entity Type:Individual
Prefix:
First Name:KORINNE
Middle Name:ELON
Last Name:DAVIS-LOBBAN
Suffix:
Gender:F
Credentials: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 7705
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-7705
Mailing Address - Country:US
Mailing Address - Phone:619-300-5446
Mailing Address - Fax:619-300-5446
Practice Address - Street 1:19321 GROVE COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-8113
Practice Address - Country:US
Practice Address - Phone:951-571-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT99320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist