Provider Demographics
NPI:1689002669
Name:CORNERSTONE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-722-4166
Mailing Address - Street 1:221 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2217
Mailing Address - Country:US
Mailing Address - Phone:330-722-4166
Mailing Address - Fax:330-725-5792
Practice Address - Street 1:221 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2217
Practice Address - Country:US
Practice Address - Phone:330-722-4166
Practice Address - Fax:330-725-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH607329Medicaid