Provider Demographics
NPI:1740876523
Name:BIGHEART, CORBIN (LCDC-I)
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:
Last Name:BIGHEART
Suffix:
Gender:M
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 ALLEYTON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-2943
Mailing Address - Country:US
Mailing Address - Phone:580-747-3257
Mailing Address - Fax:
Practice Address - Street 1:6409 ALLEYTON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78725-2943
Practice Address - Country:US
Practice Address - Phone:580-747-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51547101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)