| Michael Cornwall Phd Llc | |
|
2110 E Flamingo Rd Ste 207 Las Vegas NV 89119-5191 | |
| (859) 321-4956 | |
| (702) 472-8635 |
| Full Name | Michael Cornwall Phd Llc |
|---|---|
| Speciality | Counselor |
| Location | 2110 E Flamingo Rd Ste 207, Las Vegas, Nevada |
| Authorized Official Name and Position | Michael Cornwall (PROVIDER) |
| Authorized Official Contact | 8593214956 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Cornwall Phd Llc 7115 Pico Rio Ct Las Vegas NV 89156-7154 Ph: (859) 321-4956 | Michael Cornwall Phd Llc 2110 E Flamingo Rd Ste 207 Las Vegas NV 89119-5191 Ph: (859) 321-4956 |
| NPI Number | 1699531731 |
|---|---|
| Provider Enumeration Date | 02/26/2024 |
| Last Update Date | 03/02/2024 |
| Certification Date | 03/02/2024 |
| Medicare PECOS PAC ID | 8527409457 |
|---|---|
| Medicare Enrollment ID | O20240509002587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699531731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Michael Robert Cornwall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184921033 PECOS PAC ID: 9436590361 Enrollment ID: I20240509002651 |
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