Provider Demographics
NPI:1154578649
Name:CORBETT, JENNIFER ALIA (M ED)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALIA
Last Name:CORBETT
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2414
Mailing Address - Country:US
Mailing Address - Phone:602-764-2052
Mailing Address - Fax:
Practice Address - Street 1:2005 E HARVARD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2414
Practice Address - Country:US
Practice Address - Phone:602-764-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3201026101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool