Provider Demographics
NPI:1821011859
Name:CORNELL, KAREN M (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:CORNELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 CORK PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1509
Mailing Address - Country:US
Mailing Address - Phone:530-756-2849
Mailing Address - Fax:530-756-5111
Practice Address - Street 1:603 G ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3725
Practice Address - Country:US
Practice Address - Phone:530-383-1592
Practice Address - Fax:530-756-5111
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health