Provider Demographics
NPI:1720219561
Name:CORNELL, ROBERT BRUCE (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:CORNELL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 SINALOA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3152
Mailing Address - Country:US
Mailing Address - Phone:626-398-5581
Mailing Address - Fax:626-398-4421
Practice Address - Street 1:867 ATCHISON ST
Practice Address - Street 2:WESTMINSTER COUNSELING CENTER
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2314
Practice Address - Country:US
Practice Address - Phone:626-991-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA42969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health