Kenneth Lake Cornog

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

R9487 Issued in OR

Practice address

3231 SE 50TH Ave
Portland, OR 97206-2248

Phone

(503) 238-5203

NPI assigned

Sep 11, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1962289470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 SE 29TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143028",
            "telephone_number": "518-409-6158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 SE 50TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972062248",
            "telephone_number": "503-238-5203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNOG",
        "first_name": "KENNETH",
        "middle_name": "LAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-11",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R9487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cornerstone Natural Medicine LLC
• Estonia Cornett
• Kelvina Cornett
• Patrick James Corning, D.M.D., MS
• Rachel Margaret Cornish
• Sandra Megan Cornwall, QMHA
• David Quinlin Cornwell
• Holly Jean Cornwell, RN
• Martha Corona-Goldstein, LCSW
• Angelina Cynthia Jean Corona

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.