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General NPI Number Information
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NPI Number | 1881067643
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Entity Type | Individual
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Provider Name | CORI ETTELSON LPC
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Gender | Female
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 418 STUMP RD STE 205
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City | MONTGOMERYVILLE
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State | PA
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Zip | 18936-9645
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Country | US
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Telephone | 267-405-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 561 DOGWOOD DR
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City | AMBLER
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State | PA
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Zip | 19002-6109
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC008389
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License Number State | PA
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