Basic Information
| Provider Information | |||||||||
| NPI: | 1528296027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COREY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12835 POINTE DEL MAR WAY | ||||||||
| Address2: | |||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920143846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582590599 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 602 E NOB HILL BLVD | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989013534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092483334 | ||||||||
| FaxNumber: | 5094536144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC48962 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | MK61313533 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 12577155 | 01 | CAQH PROVIDER ID 12577155 | OTHER |