Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 61113 | TX |
NPI | 1003012774 |
---|---|
Provider Name | Dana Marie Corbett-Mullen |
First Address | Waco, TX 76710-4427 |
Second Address | Waco, TX 76710-4427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |