Provider Demographics
NPI:1851317325
Name:PINNELL, CORNELIA (PHD)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:PINNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18205 N 51ST AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1491
Mailing Address - Country:US
Mailing Address - Phone:623-979-8290
Mailing Address - Fax:602-548-1446
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:BLGD 2 SUITE 115
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:623-915-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist