Provider Demographics
NPI:1043071152
Name:CORNELIUS, DEANNA JEANE (LPC-A)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JEANE
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 SADDLE VIS
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3658
Mailing Address - Country:US
Mailing Address - Phone:254-760-3357
Mailing Address - Fax:
Practice Address - Street 1:16607 BLANCO RD STE 1107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1961
Practice Address - Country:US
Practice Address - Phone:210-816-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health