Provider Demographics
NPI:1427523752
Name:CORNE, EMILY D (LAC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:CORNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DOUGLAS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2904
Mailing Address - Country:US
Mailing Address - Phone:316-759-9136
Mailing Address - Fax:
Practice Address - Street 1:300 W DOUGLAS AVE STE 205
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2904
Practice Address - Country:US
Practice Address - Phone:316-759-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS597101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty