Provider Demographics
NPI:1982065538
Name:CORLEY, BRETT ALAN (M ED, LPCC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALAN
Last Name:CORLEY
Suffix:
Gender:M
Credentials:M ED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8878
Mailing Address - Country:US
Mailing Address - Phone:502-381-5617
Mailing Address - Fax:
Practice Address - Street 1:171 ALPINE DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8878
Practice Address - Country:US
Practice Address - Phone:502-381-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100403260Medicaid