Basic Information
| Provider Information | |||||||||
| NPI: | 1235492042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORSE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1916 NE 70TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973679419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419968129 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4422 NE DEVILS LAKE BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973675000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412654196 | ||||||||
| FaxNumber: | 5419941882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 11-09-09 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | C3323 | OR | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | C3323 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.