Provider Demographics
NPI:1346547510
Name:CORNELIUS, JAMES (CADC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-3339
Mailing Address - Country:US
Mailing Address - Phone:541-523-3841
Mailing Address - Fax:541-523-3841
Practice Address - Street 1:2013 1ST ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3339
Practice Address - Country:US
Practice Address - Phone:541-523-3841
Practice Address - Fax:541-523-3841
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09-P-15101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)