Provider Demographics
NPI:1396439873
Name:CORNERSTONE PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-289-2642
Mailing Address - Street 1:PO BOX 150629
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0629
Mailing Address - Country:US
Mailing Address - Phone:509-289-2642
Mailing Address - Fax:
Practice Address - Street 1:7533 S CENTER VIEW CT STE R
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5526
Practice Address - Country:US
Practice Address - Phone:509-289-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health