Individual
JORGE CORREA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3418 GOLDBERRY LN, EUGENE, OR 97404-2037
(858) 997-7451
Mailing address
PO BOX 41153, EUGENE, OR 97404-0306
(858) 997-7451
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT86204
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMFT86204
LICENSE
CA
Enumeration date
05/27/2021
Last updated
04/26/2024
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