Provider Demographics
NPI:1538540331
Name:BROSCH, CORY (LMFT)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:BROSCH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:
Other - Last Name:BROSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 10668
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-0668
Mailing Address - Country:US
Mailing Address - Phone:657-859-9779
Mailing Address - Fax:
Practice Address - Street 1:2030 E. FOURTH
Practice Address - Street 2:C131
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:657-859-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist