Provider Demographics
NPI:1417207671
Name:CORNWELL, SHELLI L (LIMHP, LADC, PC)
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:L
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:LIMHP, LADC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-562-6767
Mailing Address - Fax:402-562-6770
Practice Address - Street 1:1460 35TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-562-6767
Practice Address - Fax:402-562-6770
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10028961800Medicaid