Provider Demographics
NPI:1811295587
Name:CORLETT, KRYSTEN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KRYSTEN
Middle Name:
Last Name:CORLETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KRYSTEN
Other - Middle Name:MARIE
Other - Last Name:RIGNANESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MARC DR APT 1B10
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6104
Mailing Address - Country:US
Mailing Address - Phone:619-246-7655
Mailing Address - Fax:
Practice Address - Street 1:34 MAIN STREET EXT STE 103
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3375
Practice Address - Country:US
Practice Address - Phone:508-830-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health