Provider Demographics
NPI:1659623130
Name:CORNERSTONE CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CORNERSTONE CLINICAL SERVICES, INC.
Other - Org Name:CORNERSTONE OF TEXAS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:580-470-8898
Mailing Address - Street 1:1408 W ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4022
Mailing Address - Country:US
Mailing Address - Phone:580-470-8898
Mailing Address - Fax:888-411-3004
Practice Address - Street 1:308 BELCHER ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-3630
Practice Address - Country:US
Practice Address - Phone:580-445-5494
Practice Address - Fax:888-411-3004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CLINICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health