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NPI Code Detail

MEDICARE: MS. MAURA KATHLEEN CORNELL LPC

MEDICARE: MS. MAURA KATHLEEN CORNELL LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor60583TX

General Provider Information

NPI Number : 1275772246
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAURA KATHLEEN CORNELL LPC
Provider Business Mailing Address
First Line : 8260 SAN CRISTOBAL DR
Second Line :
City : DALLAS
State : TX
Zip : 75218-4432
Country : US
Telephone Number : 214-684-7881
Fax Number :
Provider Business Practice Location Address
First Line : 9708 SKILLMAN ST
Second Line :
City : DALLAS
State : TX
Zip : 75243-5150
Country : US
Telephone Number : 214-684-7881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2009
Last Update Date : 02/13/2009

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