Provider Demographics
NPI:1326283052
Name:CORNISH, KELLY M (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:CORNISH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:M
Other - Last Name:GLASSMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT-T, MFT-I
Mailing Address - Street 1:1740 PLUM LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:909-266-7576
Mailing Address - Fax:909-363-9202
Practice Address - Street 1:1740 PLUM LANE
Practice Address - Street 2:SUITE B
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-557-6574
Practice Address - Fax:909-363-9202
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA77572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist