Provider Demographics
NPI:1528296027
Name:COREY, DEBORAH (MFT)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 BEVERLY AVE NE STE 40
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1374
Mailing Address - Country:US
Mailing Address - Phone:503-588-0076
Mailing Address - Fax:503-588-7578
Practice Address - Street 1:3896 BEVERLY AVE NE STE 40
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1374
Practice Address - Country:US
Practice Address - Phone:503-588-0076
Practice Address - Fax:503-588-7578
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48962106H00000X
WAMK61313533106H00000X
ORT2399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12577155OtherCAQH PROVIDER ID 12577155