TANJA DAWN CORNELISON LCPC
NPI 1215188479
Counselor - Mental Health in Chubbuck, ID

Q: What is Tanja Cornelison's NPI number?

The NPI number for Tanja Cornelison is 1215188479. It was assigned to this individual provider in the NPPES registry on October 7, 2008.

Q: What is Tanja Cornelison's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Tanja Cornelison was last updated on June 2, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 07, 2008PECOS Enrolled

265 E CHUBBUCK RD, CHUBBUCK, ID 83202(208) 237-1711(208) 237-9806 Get Directions Write a Review

NPPES record last updated: June 2, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Tanja Dawn Cornelison Lcpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TANJA DAWN CORNELISON LCPC (NPI 1215188479) is an individual mental health provider in Chubbuck, Idaho, licensed in Idaho (LCPC-6510) and active in the NPI registry since October 2008. She is enrolled in Medicare PECOS and is a graduate of Other (2005).

NPPES Registry Identity

NPI1215188479

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameTANJA DAWN CORNELISONCredential: LCPC

Location Address265 E CHUBBUCK RDChubbuck, ID 83202-5055

Mailing Address265 E Chubbuck RdChubbuck, ID 83202-5055 · (208) 237-1711 · Fax (208) 237-9806

Phone(208) 237-1711

Fax(208) 237-9806

Sole ProprietorNo

Medical School CMSOtherGraduated 2005

Enumeration DateOctober 7, 2008

Last NPPES UpdateJune 2, 2026

NPPES CertifiedJune 2, 2026

✔ NPI 1215188479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in ID · LCPC-6510

265 E CHUBBUCK RD, Chubbuck, ID 83202

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tanja Dawn Cornelison Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2163902966

PECOS Enrollment IDI20260218004417

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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