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General NPI Number Information
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NPI Number | 1952656357
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Entity Type | Individual
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Provider Name | DAVID RAY CORDLE JR. LPC
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Gender | Male
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Dates
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Enumeration Date | 07/21/2012
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 473 ELKS LODGE RD
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City | PAWHUSKA
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State | OK
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Zip | 74056-6542
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Country | US
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Telephone | 539-212-2499
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Fax |
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Provider Business Mailing Address
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Address Line | 604 HICKORY DR
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City | CLEVELAND
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State | OK
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Zip | 74020-1002
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Country | US
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Telephone | 918-287-5420
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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 | 5951
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5951
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License Number State | OK
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