Provider Demographics
NPI:1326154378
Name:CORNERSTONE COUNSELING SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A.O.D.A. COUNSLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:CADCIII
Authorized Official - Phone:262-542-3255
Mailing Address - Street 1:4811 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:414-817-0442
Mailing Address - Fax:414-817-0442
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-817-0442
Practice Address - Fax:414-817-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI684101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39356400Medicaid