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General NPI Number Information
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NPI Number | 1912116161
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Entity Type | Individual
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Provider Name | NAN CECILE CORDY LICENSE IN PROGRESS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 211 E. ELLENDALE SUITE #7
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City | DALLAS
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State | OR
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Zip | 97338
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Country | US
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Telephone | 503-831-5831
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Fax | 503-623-2505
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Provider Business Mailing Address
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Address Line | 8260 SMITH RD
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City | MONMOUTH
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State | OR
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Zip | 97361-9645
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Country | US
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Telephone | 503-623-6812
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Fax | 503-623-2505
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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 | REGISTERED INTERN
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License Number State | OR
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