Individual
JASON CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED., CM-A
Contact information
Practice address
90 N 31ST, CLINTON, OK 73601
(580) 323-0312
Mailing address
132 MCKENZIE DR, WEATHERFORD, OK 73096-4327
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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