Provider Demographics
NPI:1295947687
Name:CORNERSTONE PSYCHOLOGIST, PS
Entity type:Organization
Organization Name:CORNERSTONE PSYCHOLOGIST, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-455-8886
Mailing Address - Street 1:1525 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3414
Mailing Address - Country:US
Mailing Address - Phone:509-455-8886
Mailing Address - Fax:509-455-8887
Practice Address - Street 1:1525 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3414
Practice Address - Country:US
Practice Address - Phone:509-455-8886
Practice Address - Fax:509-455-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2057103TC0700X
WAPY1950103TC0700X
WAAP30005127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS85474Medicare UPIN