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Individual

MAE LYNN CORWIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-4000
(541) 523-4927

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-20-168
OR
175T00000X
Peer Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500781022
OR
01
T-20-168
CADC-R CERTIFICATE
OR
Enumeration date
04/14/2020
Last updated
12/08/2020
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