Provider Demographics
NPI:1881928141
Name:CORDAIN, CONSTANCE M (LMFT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:CORDAIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 E VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7909
Mailing Address - Country:US
Mailing Address - Phone:928-774-0954
Mailing Address - Fax:
Practice Address - Street 1:1016 W UNIVERSITY AVE
Practice Address - Street 2:#209
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2994
Practice Address - Country:US
Practice Address - Phone:928-774-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMFT-0359106H00000X
CAMFC-28974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist