Provider Demographics
NPI:1487077913
Name:HOLBROOK, CORISSA I
Entity type:Individual
Prefix:MS
First Name:CORISSA
Middle Name:
Last Name:HOLBROOK
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E FLAMINGO RD
Mailing Address - Street 2:STE 158
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5258
Mailing Address - Country:US
Mailing Address - Phone:702-272-8619
Mailing Address - Fax:
Practice Address - Street 1:1555 E FLAMINGO RD
Practice Address - Street 2:STE 158
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5258
Practice Address - Country:US
Practice Address - Phone:702-272-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health