Provider Demographics
NPI:1861636904
Name:CORNELIUS, RACHELLE LYNN (MA)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LYNN
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5103
Mailing Address - Country:US
Mailing Address - Phone:541-514-7997
Mailing Address - Fax:
Practice Address - Street 1:739 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5103
Practice Address - Country:US
Practice Address - Phone:541-514-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional