Healthcare Provider Details

I. General information

NPI: 1932033727
Provider Name (Legal Business Name): JAMES JASON CORNELIUS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 CORNELIUS CT
KELLER TX
76248-2281
US

IV. Provider business mailing address

1205 CORNELIUS CT
KELLER TX
76248-2281
US

V. Phone/Fax

Practice location:
  • Phone: 817-754-0417
  • Fax:
Mailing address:
  • Phone: 817-754-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: