Provider Demographics
NPI:1407569569
Name:CORNWELL, LEAH A (PROF COUNSELOR ASSOC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:PROF COUNSELOR ASSOC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:849 RIVERSIDE DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4292
Mailing Address - Country:US
Mailing Address - Phone:541-891-3247
Mailing Address - Fax:
Practice Address - Street 1:849 RIVERSIDE DR UNIT 8
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4292
Practice Address - Country:US
Practice Address - Phone:541-891-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7665101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor