| Doctor Name: | TANJA DAWN CORNELISON |
| NPI Number: | 1215188479 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC-3452 |
| Business Practice Address: | 210 E Center St Ste B Pocatello, ID - 832016326 |
| Business Phone Number: | 2082342600 |
| Business Fax Number: | 2082342800 |
| Mailing Address: | 5140 Constitution Ave, CHUBBUCK |
| State: | ID |
| Postal Code: | 832023076 |
| Phone Number: | 2086040155 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2008 |
| NPI Last Update Date: | 10/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | LPC-3452 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |