Provider Demographics
NPI:1083852354
Name:CORONA, JAIME (LPC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:CORONA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10117
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-0117
Mailing Address - Country:US
Mailing Address - Phone:817-624-1222
Mailing Address - Fax:817-460-0286
Practice Address - Street 1:4805 GREEN OAKS DR
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-3004
Practice Address - Country:US
Practice Address - Phone:817-624-1222
Practice Address - Fax:817-460-0286
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX63032101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202545405Medicaid
TX202545401Medicaid
TX202545403Medicaid
TX202545402Medicaid