Provider Demographics
NPI:1851819544
Name:CORNERSTONE COUNSELING CLINIC, INC.
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESSHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-455-0134
Mailing Address - Street 1:508 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-3925
Mailing Address - Country:US
Mailing Address - Phone:870-455-0134
Mailing Address - Fax:870-277-2230
Practice Address - Street 1:508 N 2ND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3925
Practice Address - Country:US
Practice Address - Phone:870-285-1413
Practice Address - Fax:870-285-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-02
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228679526Medicaid