Doctor Name: | CORRINA S. LINDBLOM |
NPI Number: | 1316149669 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, EDS, LEP |
License Number: | LEP 2910 |
Business Practice Address: | 150 Big Trees Rd Suite A Murphys, CA - 952479101 |
Business Phone Number: | 2097282184 |
Business Fax Number: | |
Mailing Address: | 20545 Eureka Dr, SONORA |
State: | CA |
Postal Code: | 953707812 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | LEP 2910 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |