Provider Demographics
NPI:1780735597
Name:CORDELL ASSOCIATES, LLC
Entity type:Organization
Organization Name:CORDELL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-276-3356
Mailing Address - Street 1:6500 POE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2527
Mailing Address - Country:US
Mailing Address - Phone:937-276-3356
Mailing Address - Fax:937-276-9514
Practice Address - Street 1:6520 POE AVE STE 200
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2856
Practice Address - Country:US
Practice Address - Phone:937-276-3356
Practice Address - Fax:937-276-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140207Medicaid
OH0140207Medicaid