Provider Demographics
NPI:1437985579
Name:CORBETT, TY R
Entity type:Individual
Prefix:
First Name:TY
Middle Name:R
Last Name:CORBETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 MCLAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3940
Mailing Address - Country:US
Mailing Address - Phone:616-432-0908
Mailing Address - Fax:
Practice Address - Street 1:766 MCLAUGHLIN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3940
Practice Address - Country:US
Practice Address - Phone:616-432-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician