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NPI Code Detail

MEDICARE: CORDELL ASSOCIATES, LLC

MEDICARE: CORDELL ASSOCIATES, LLC
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
1103TC0700XClinical Psychologist5179OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780735597
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORDELL ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 6500 POE AVE STE 400
Second Line :
City : DAYTON
State : OH
Zip : 45414-2527
Country : US
Telephone Number : 937-276-3356
Fax Number : 937-276-9514
Provider Business Practice Location Address
First Line : 6500 POE AVE STE 400
Second Line :
City : DAYTON
State : OH
Zip : 45414-2527
Country : US
Telephone Number : 937-276-3356
Fax Number : 937-276-9514
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : MARCY J GUNN
Credential : PSYD
Telephone Number : 937-276-3356
Provider Enumeration Date : 01/16/2007
Last Update Date : 09/16/2025

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Directions to “CORDELL ASSOCIATES, LLC ” Practice Location

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