Provider Demographics
NPI:1437807377
Name:CORNERSTONE COUNSELING, BRANDON DIXON LLC
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING, BRANDON DIXON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-222-2309
Mailing Address - Street 1:2909 BENT AVE UNIT B1
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2742
Mailing Address - Country:US
Mailing Address - Phone:307-222-2309
Mailing Address - Fax:
Practice Address - Street 1:2909 BENT AVE UNIT B1
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2742
Practice Address - Country:US
Practice Address - Phone:307-222-2309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty