Provider Demographics
NPI:1275772246
Name:CORNELL, MAURA KATHLEEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:KATHLEEN
Last Name:CORNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 SAN CRISTOBAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4432
Mailing Address - Country:US
Mailing Address - Phone:214-684-7881
Mailing Address - Fax:
Practice Address - Street 1:9708 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5150
Practice Address - Country:US
Practice Address - Phone:214-684-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health