Provider Demographics
NPI:1922353119
Name:CORNERSTONE COUNSELING SERVICE, L.L.C.
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING SERVICE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:BHRS
Authorized Official - Phone:580-326-2200
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-0061
Mailing Address - Country:US
Mailing Address - Phone:580-326-2200
Mailing Address - Fax:580-326-2201
Practice Address - Street 1:612 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743
Practice Address - Country:US
Practice Address - Phone:580-326-2200
Practice Address - Fax:580-326-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200452460AMedicaid