Provider Demographics
NPI:1497987291
Name:CORDRAY, JOHN PAUL (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:CORDRAY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2417
Mailing Address - Country:US
Mailing Address - Phone:636-226-8536
Mailing Address - Fax:
Practice Address - Street 1:1230 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7686
Practice Address - Country:US
Practice Address - Phone:636-226-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007025740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional