Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 1309 | OK |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1309 | OK |
Y | 103G00000X | Clinical Psychologist | 1309 | OK |
Y | 103TC0700X | Clinical Psychologist | 1309 | OK |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1309 | OK |
N | 103TH0100X | Health Service | 1309 | OK |
NPI | 1194216374 |
---|---|
Provider Name | Dr. Sonya Lynn Cornwell |
First Address | Tahlequah, OK 74464-3824 |
Second Address | Tahlequah, OK 74464-3824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2018 |
Last Update Date | 25/09/2019 |