Individual
TAMARA LEIGH CORRALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1504 LEANDER RD, GEORGETOWN, TX 78628-8801
(512) 868-6367
(512) 864-0930
Mailing address
129 FAIRFIELD CT, GEORGETOWN, TX 78628-4655
(512) 868-6367
(512) 864-0930
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
18986
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1660409
—
TX
01
—
6560LC
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/22/2006
Last updated
07/08/2007
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