Provider Demographics
NPI:1053500280
Name:CORNELIUS, NORA DOREEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:NORA
Middle Name:DOREEN
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040-0746
Mailing Address - Country:US
Mailing Address - Phone:509-301-3638
Mailing Address - Fax:
Practice Address - Street 1:4556 SMOKEY LANE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:WA
Practice Address - Zip Code:99173
Practice Address - Country:US
Practice Address - Phone:509-301-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004093101YA0400X
WALH00009315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602766698OtherUBI NUMBER