Provider Demographics
NPI:1194169789
Name:CORDIAL, MAUREEN (LCPC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:CORDIAL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6743 LINDA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2769
Mailing Address - Country:US
Mailing Address - Phone:406-459-7636
Mailing Address - Fax:406-830-3144
Practice Address - Street 1:1410 S RESERVE ST STE C
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4701
Practice Address - Country:US
Practice Address - Phone:406-459-7636
Practice Address - Fax:406-830-3144
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health