Basic Information
| Provider Information | |||||||||
| NPI: | 1851785216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COROLLA HEALTH PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 352 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN IRON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557680352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183121225 | ||||||||
| FaxNumber: | 8886804314 | ||||||||
| Practice Location | |||||||||
| Address1: | 3920 13TH AVE E | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183121225 | ||||||||
| FaxNumber: | 8886804314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | CHANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2183121225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP0016X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) |
No ID Information.