Individual
BRENT LAWRENCE CORVALAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
152 1ST AVE N, ILWACO, WA 98624-9137
(360) 261-6930
Mailing address
PO BOX 1447, CHEHALIS, WA 98532-0378
(360) 261-6930
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/20/2022
Last updated
12/20/2022
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