Healthcare Provider Details

I. General information

NPI: 1144791898
Provider Name (Legal Business Name): CIERA CORNELIOUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 ONEAL LN
BATON ROUGE LA
70816-1874
US

IV. Provider business mailing address

862 ONEAL LN
BATON ROUGE LA
70816-1874
US

V. Phone/Fax

Practice location:
  • Phone: 225-275-3039
  • Fax:
Mailing address:
  • Phone: 225-275-3039
  • Fax: 225-275-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: