Provider Demographics
NPI:1609327329
Name:CORNERSTONE MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-942-1148
Mailing Address - Street 1:2104 CROSSBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8716
Mailing Address - Country:US
Mailing Address - Phone:601-487-8630
Mailing Address - Fax:
Practice Address - Street 1:2104 CROSSBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8716
Practice Address - Country:US
Practice Address - Phone:601-487-8630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875679261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)