Provider Demographics
NPI:1073805834
Name:CLANCY GRABER, CORINNE RENEE (LAMFT)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:RENEE
Last Name:CLANCY GRABER
Suffix:
Gender:
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 MOORSBRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4422
Mailing Address - Country:US
Mailing Address - Phone:269-762-1010
Mailing Address - Fax:
Practice Address - Street 1:8080 MOORSBRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4422
Practice Address - Country:US
Practice Address - Phone:269-762-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist