Provider Demographics
NPI:1477033546
Name:CORNETT, HEATHER LAUREN (PHD, LP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAUREN
Last Name:CORNETT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3044
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3044
Mailing Address - Country:US
Mailing Address - Phone:606-687-2038
Mailing Address - Fax:606-200-3654
Practice Address - Street 1:200 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2419
Practice Address - Country:US
Practice Address - Phone:606-687-2038
Practice Address - Fax:606-200-3654
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2766103TC1900X
KS2867103TC1900X
KY282020103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical