Provider Demographics
NPI:1912309592
Name:MAUREEN CORDIAL, LMFT, LCPC, PLLC
Entity Type:Organization
Organization Name:MAUREEN CORDIAL, LMFT, LCPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ELOISE
Authorized Official - Last Name:CORDIAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LCPC
Authorized Official - Phone:406-721-8858
Mailing Address - Street 1:701 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3904
Mailing Address - Country:US
Mailing Address - Phone:406-721-8858
Mailing Address - Fax:
Practice Address - Street 1:701 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3904
Practice Address - Country:US
Practice Address - Phone:406-721-8858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMFT-4491261QM0850X
MTLCPC-4492261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health