Provider Demographics
NPI:1952656357
Name:CORDLE, DAVID RAY JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAY
Last Name:CORDLE
Suffix:JR
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 1:604 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-1002
Mailing Address - Country:US
Mailing Address - Phone:918-287-5420
Mailing Address - Fax:
Practice Address - Street 1:100 W MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-4149
Practice Address - Country:US
Practice Address - Phone:918-287-5413
Practice Address - Fax:918-287-5234
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-21
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5951101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200498140BMedicaid