Provider Demographics
NPI:1194191601
Name:CORNERSTONE CLINICAL SERVICES, INC
Entity Type:Organization
Organization Name:CORNERSTONE CLINICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-595-7000
Mailing Address - Street 1:507 S WILLOW ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-3849
Mailing Address - Country:US
Mailing Address - Phone:405-207-9131
Mailing Address - Fax:888-411-3004
Practice Address - Street 1:1408 W ELDER AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4022
Practice Address - Country:US
Practice Address - Phone:580-595-7000
Practice Address - Fax:580-595-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100747400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747400CMedicaid