Provider Demographics
NPI:1063043776
Name:CORBETT, JOHN R (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:CORBETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 E HAVASU RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2519
Mailing Address - Country:US
Mailing Address - Phone:520-904-7941
Mailing Address - Fax:
Practice Address - Street 1:4421 E HAVASU RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-2519
Practice Address - Country:US
Practice Address - Phone:520-904-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical