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NPI Code Detail

MEDICARE: MRS. LAURA ELIZABETH CORNELY M.A.

MEDICARE: MRS. LAURA ELIZABETH CORNELY M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorE0003589OH

General Provider Information

NPI Number : 1679645774
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA ELIZABETH CORNELY M.A.
Provider Business Mailing Address
First Line : 1771 ROYAL OAK DR
Second Line :
City : LEWIS CENTER
State : OH
Zip : 43035-6089
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 199 S CENTRAL AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-1301
Country : US
Telephone Number : 614-274-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/08/2007

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