Provider Demographics
NPI:1043257876
Name:CORDER, JUSTIN R (LCSW)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:R
Last Name:CORDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:116A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-0895
Mailing Address - Fax:214-857-0902
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:116A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0895
Practice Address - Fax:214-857-0902
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22642104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22642OtherLMSW LICENSE NUMBER