Provider Demographics
NPI:1689778367
Name:CORNERSTONE CLINICAL & TRAINING SERVICES, INC.
Entity Type:Organization
Organization Name:CORNERSTONE CLINICAL & TRAINING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OMOTAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:708-291-0079
Mailing Address - Street 1:2853 W 98TH PL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2614
Mailing Address - Country:US
Mailing Address - Phone:708-291-0079
Mailing Address - Fax:708-857-9417
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:708-291-0079
Practice Address - Fax:708-857-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634317OtherBLUECROSSBLUESHIELD
IL515000OtherPSYCHEALTH, LTD
IL234943OtherCOMPSYCH