Corvell Coburn, LCSW, RN

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C11412 Issued in MS

Practice address

262 King Rd
Hattiesburg, MS 39402-8503

Phone

(662) 769-1024

NPI assigned

Mar 22, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Leaf Therapy LLC

  • Adult Mental Health Clinic/Center
  • Hattiesburg, MS
  • NPI 1134914104
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1124559232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 KING RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028503",
            "telephone_number": "662-769-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 KING RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028503",
            "telephone_number": "662-769-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "CORVELL",
        "name_prefix": "Mr.",
        "credential": "LCSW, RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-22",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MS",
            "license": "906622",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C11412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Clemmons, PHD
• Clayton W Clifton Jr., RPH
• Ethan Clopton
• Coastal Pharmacy Services LLC
• Jessica Elisabeth Coates
• Curtis W Cochran, NP
• Jennifer McDowell Cochran, MS CCC/SLP
• Leigh Ann Cochran, FNP-C
• Shelley S Cochran, FNP
• Tracy A Cochran

• Clinical Social Worker in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.