Provider Demographics
NPI:1245679794
Name:CORDES, COLLEEN C (PHD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:C
Last Name:CORDES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:E
Other - Last Name:CLEMENCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7301 E 2ND ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5600
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:480-882-6804
Practice Address - Street 1:7301 E 2ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:480-882-6804
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4155103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling