Provider Demographics
NPI:1912116161
Name:CORDY, NAN CECILE (LICENSE IN PROGRESS)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:CECILE
Last Name:CORDY
Suffix:
Gender:F
Credentials:LICENSE IN PROGRESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-9645
Mailing Address - Country:US
Mailing Address - Phone:503-623-6812
Mailing Address - Fax:503-623-2505
Practice Address - Street 1:211 E. ELLENDALE SUITE #7
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338
Practice Address - Country:US
Practice Address - Phone:503-831-5831
Practice Address - Fax:503-623-2505
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORREGISTERED INTERN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health