Provider Demographics
NPI:1164730842
Name:CORNWELL, WILLIAM III
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CORNWELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 31ST AVE E
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4826
Mailing Address - Country:US
Mailing Address - Phone:334-294-9245
Mailing Address - Fax:
Practice Address - Street 1:1812 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2843
Practice Address - Country:US
Practice Address - Phone:425-610-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health