Provider Demographics
NPI:1194489633
Name:LORD, KORRIN MELISSA (BA)
Entity type:Individual
Prefix:MRS
First Name:KORRIN
Middle Name:MELISSA
Last Name:LORD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 S BRUCE ST APT 45
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1741
Mailing Address - Country:US
Mailing Address - Phone:760-610-3946
Mailing Address - Fax:
Practice Address - Street 1:2665 S BRUCE ST APT 45
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1741
Practice Address - Country:US
Practice Address - Phone:760-610-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health