Provider Demographics
NPI:1346791688
Name:CORNERSTONE FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:574-310-2410
Mailing Address - Street 1:1415 LINCOLNWAY W
Mailing Address - Street 2:SUITE T
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-2062
Mailing Address - Country:US
Mailing Address - Phone:574-651-8912
Mailing Address - Fax:
Practice Address - Street 1:1415 LINCOLNWAY W
Practice Address - Street 2:SUITE T
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2062
Practice Address - Country:US
Practice Address - Phone:574-651-8912
Practice Address - Fax:574-281-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002932A101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty