Provider Demographics
NPI:1194755835
Name:CORNELIUS, CHERYL (MET)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MET
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 33310
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3310
Mailing Address - Country:US
Mailing Address - Phone:702-256-6090
Mailing Address - Fax:702-256-1310
Practice Address - Street 1:7375 PRAIRIE FALCON
Practice Address - Street 2:160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0818
Practice Address - Country:US
Practice Address - Phone:702-256-6090
Practice Address - Fax:702-256-6090
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLADC00684101YA0400X
NVMFT0433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A963073OtherVALUE OPTIONS