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General NPI Number Information
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NPI Number | 1194169789
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Entity Type | Individual
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Provider Name | MAUREEN CORDIAL LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 1410 S RESERVE ST STE C
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City | MISSOULA
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State | MT
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Zip | 59801-4701
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Country | US
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Telephone | 406-459-7636
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Fax | 406-830-3144
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Provider Business Mailing Address
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Address Line | 6743 LINDA VISTA BLVD
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City | MISSOULA
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State | MT
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Zip | 59803-2769
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Country | US
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Telephone | 406-459-7636
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Fax | 406-830-3144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4492
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License Number State | MT
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