Doctor Name: | MARK WALTER CORNELIUS |
NPI Number: | 1649324203 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S., M.A. LCPC |
License Number: | LCPC 291 |
Business Practice Address: | 421 E Coeur Dalene Ave Suite 2 Coeur D Alene, ID - 838141704 |
Business Phone Number: | 2086641606 |
Business Fax Number: | 2086649685 |
Mailing Address: | Po Box 1677, COEUR D ALENE |
State: | ID |
Postal Code: | 838161677 |
Phone Number: | 2086641606 |
Fax Number: | 2086649685 |
NPI Enumeration Date: | 01/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LCPC 291 |
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 |