Provider Demographics
NPI:1487789426
Name:CORAZAO, LYNN N (MA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:N
Last Name:CORAZAO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1600
Mailing Address - Country:US
Mailing Address - Phone:713-774-2122
Mailing Address - Fax:713-774-3223
Practice Address - Street 1:8303 SOUTHWEST FWY
Practice Address - Street 2:SUITE 330
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1600
Practice Address - Country:US
Practice Address - Phone:713-774-2122
Practice Address - Fax:713-774-3223
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16215101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82833LOtherBLUE CROSS & BLUE SHIELD