Provider Demographics
NPI:1407610686
Name:CORNELIUS, JUDITH (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:O
Other - Last Name:CORNELIUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:1718 WELCH ST APT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1790
Mailing Address - Country:US
Mailing Address - Phone:817-988-0372
Mailing Address - Fax:
Practice Address - Street 1:1718 WELCH ST APT A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1790
Practice Address - Country:US
Practice Address - Phone:817-988-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health