Provider Demographics
NPI:1174059554
Name:CORNETT, NICHOLAS (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:CORNETT
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3503
Mailing Address - Country:US
Mailing Address - Phone:479-283-1923
Mailing Address - Fax:
Practice Address - Street 1:2105 S 54TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8169
Practice Address - Country:US
Practice Address - Phone:479-268-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1211104101YM0800X
ARM1212012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist