Provider Demographics
NPI: | 1306000724 |
---|---|
Name: | CORNERSTONE THERAPY |
Entity Type: | Organization |
Organization Name: | CORNERSTONE THERAPY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SOLE-PROPRIETOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VICTORIA |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | HOYT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCMFT |
Authorized Official - Phone: | 785-342-1012 |
Mailing Address - Street 1: | 122 N DOUGLAS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ELLSWORTH |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 67439-3214 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 785-342-1012 |
Mailing Address - Fax: | 785-225-6847 |
Practice Address - Street 1: | 122 N DOUGLAS AVE |
Practice Address - Street 2: | |
Practice Address - City: | ELLSWORTH |
Practice Address - State: | KS |
Practice Address - Zip Code: | 67439-3214 |
Practice Address - Country: | US |
Practice Address - Phone: | 785-342-1012 |
Practice Address - Fax: | 785-225-6847 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-07-15 |
Last Update Date: | 2008-07-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 06920863 | 324500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |