Individual
CHARLES CORUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
510 W 10TH ST, LYNN HAVEN, FL 32444-2329
(575) 649-6044
Mailing address
6926 PITTSBURGH ST, PANAMA CITY, FL 32404
(575) 649-6044
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-19-38776
FL
103K00000X
Behavior Analyst
Primary
1-19-38776
—
106S00000X
Behavior Technician
247200000X
FL
Other
Enumeration date
12/19/2016
Last updated
11/16/2023
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