Provider Demographics
NPI:1841883832
Name:COUNSELING BY CORYANNA, PLLC
Entity type:Organization
Organization Name:COUNSELING BY CORYANNA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORYANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:734-787-8966
Mailing Address - Street 1:4049 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-7229
Mailing Address - Country:US
Mailing Address - Phone:734-787-8966
Mailing Address - Fax:734-794-3797
Practice Address - Street 1:343 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2116
Practice Address - Country:US
Practice Address - Phone:734-787-8966
Practice Address - Fax:734-794-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841883832Medicaid