Provider Demographics
NPI:1700895968
Name:CORNERSTONE THERAPY AND RECOVERY CENTER, P.A.
Entity Type:Organization
Organization Name:CORNERSTONE THERAPY AND RECOVERY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KOGAN-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:651-645-0980
Mailing Address - Street 1:1600 UNIVERSITY AVE W STE 505
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3825
Mailing Address - Country:US
Mailing Address - Phone:651-645-0980
Mailing Address - Fax:651-645-3534
Practice Address - Street 1:1600 UNIVERSITY AVE W STE 505
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3825
Practice Address - Country:US
Practice Address - Phone:651-645-0980
Practice Address - Fax:651-645-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty