Provider Demographics
NPI:1174765689
Name:JENAB, CORINNE MEHRI
Entity type:Individual
Prefix:MISS
First Name:CORINNE
Middle Name:MEHRI
Last Name:JENAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:MEHRI
Other - Last Name:JENAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4600 DEBARR RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3103
Mailing Address - Country:US
Mailing Address - Phone:907-222-7300
Mailing Address - Fax:
Practice Address - Street 1:4600 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3103
Practice Address - Country:US
Practice Address - Phone:650-575-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)