Provider Demographics
NPI:1902503865
Name:CORBETT-CANADA, KHALIL ELIJAH NELSON
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:ELIJAH NELSON
Last Name:CORBETT-CANADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7112
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:
Practice Address - Street 1:10782 E ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1017
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)