Provider Demographics
NPI:1982929550
Name:KATHRYN LEE CORLEY LLC
Entity Type:Organization
Organization Name:KATHRYN LEE CORLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-991-9700
Mailing Address - Street 1:10420 OLD OLIVE ST. RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-991-9700
Mailing Address - Fax:314-991-7779
Practice Address - Street 1:10420 OLD OLIVE ST. RD.
Practice Address - Street 2:SUITE 202
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-991-9700
Practice Address - Fax:314-991-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0027141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty