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General NPI Number Information
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NPI Number | 1699531731
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Entity Type | Organization
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Legal Business Name | MICHAEL CORNWALL PHD LLC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 03/02/2024
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Provider Practice Location Address
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Address Line | 2110 E FLAMINGO RD STE 207
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City | LAS VEGAS
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State | NV
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Zip | 89119-5191
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Country | US
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Telephone | 859-321-4956
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Fax | 702-472-8635
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Provider Business Mailing Address
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Address Line | 7115 PICO RIO CT
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City | LAS VEGAS
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State | NV
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Zip | 89156-7154
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Country | US
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Telephone | 859-321-4956
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MICHAEL CORNWALL
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Credential |
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Telephone | 859-321-4956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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