Healthcare Provider Details

I. General information

NPI: 1952656357
Provider Name (Legal Business Name): DAVID RAY CORDLE JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2012
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 ELKS LODGE RD
PAWHUSKA OK
74056-6542
US

IV. Provider business mailing address

604 HICKORY DR
CLEVELAND OK
74020-1002
US

V. Phone/Fax

Practice location:
  • Phone: 539-212-2499
  • Fax:
Mailing address:
  • Phone: 918-287-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5951
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5951
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: