Provider Demographics
NPI:1528077831
Name:CORNETT, SHIRLEY ANN (LMFT)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:CORNETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 PRAIRIE FALCON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4435
Mailing Address - Country:US
Mailing Address - Phone:512-221-0008
Mailing Address - Fax:
Practice Address - Street 1:5310 HOMESTEAD RD NE STE 300
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1524
Practice Address - Country:US
Practice Address - Phone:505-503-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202083106H00000X
NM201881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist