Provider Demographics
NPI:1164850699
Name:CORNERSTONE PROGRAMS
Entity Type:Organization
Organization Name:CORNERSTONE PROGRAMS
Other - Org Name:FUTURES FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-514-5592
Mailing Address - Street 1:3116 OLD FAITHFUL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5892
Mailing Address - Country:US
Mailing Address - Phone:307-514-5592
Mailing Address - Fax:307-514-5593
Practice Address - Street 1:3116 OLD FAITHFUL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5892
Practice Address - Country:US
Practice Address - Phone:307-514-5592
Practice Address - Fax:307-514-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY419103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty