Basic Information
| Provider Information | |||||||||
| NPI: | 1801445887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEMPER | ||||||||
| FirstName: | CORINE | ||||||||
| MiddleName: | ALISA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4620 TILDEN AVE APT 210 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914035732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329798224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2750 E WASHINGTON BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262968900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2019 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 103616 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | AMFT103616 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | RBT-15-3864-25456 | 01 | CA | RBT | OTHER |