Tanja Dawn Cornelison, LPC

NPI #1215188479 in Pocatello, Idaho

Provider Information

NPI Number: 1215188479
Entity Type: Individual
Name: Tanja Dawn Cornelison, LPC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Credential: LPC
Enumeration Date: Oct 7, 2008
Last Updated: Oct 7, 2008

Practice Location

Address: 210 E CENTER ST STE B
City: Pocatello
State: Idaho
ZIP Code: 83201-6326
Phone: (208) 234-2600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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