Provider Demographics
NPI:1578399309
Name:STORK, COREY ALLEN (LMSW)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ALLEN
Last Name:STORK
Suffix:
Gender:X
Credentials:LMSW
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:ALLEN
Other - Last Name:SAMPSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4513
Mailing Address - Country:US
Mailing Address - Phone:832-930-3013
Mailing Address - Fax:
Practice Address - Street 1:426 E 15TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4513
Practice Address - Country:US
Practice Address - Phone:832-930-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX113383104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health