Healthcare Provider Details

I. General information

NPI: 1013664234
Provider Name (Legal Business Name): JULIETTE D CORNELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 LYNDON CENTRE WAY STE 202
LOUISVILLE KY
40222-3604
US

IV. Provider business mailing address

8003 LYNDON CENTRE WAY STE 202
LOUISVILLE KY
40222-3604
US

V. Phone/Fax

Practice location:
  • Phone: 502-327-7701
  • Fax: 502-327-7705
Mailing address:
  • Phone: 502-327-7701
  • Fax: 502-327-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000830
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0168
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: