Individual
MR. KENNETH W CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1513 LINE AVE, SUITE 135, SHREVEPORT, LA 71101-4621
(318) 828-1455
Mailing address
1513 LINE AVE, SUITE 135, SHREVEPORT, LA 71101-4621
(318) 828-1455
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/02/2015
Last updated
05/29/2024
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