Provider Demographics
NPI: | 1952581134 |
---|---|
Name: | CORNERSTONE COUNSELING CENTER |
Entity Type: | Organization |
Organization Name: | CORNERSTONE COUNSELING CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATIVE DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ANGIE |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | ELLISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 641-856-2606 |
Mailing Address - Street 1: | 717 N 18TH ST |
Mailing Address - Street 2: | SUITE 1 |
Mailing Address - City: | CENTERVILLE |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52544-1164 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 641-856-2606 |
Mailing Address - Fax: | 641-856-2616 |
Practice Address - Street 1: | 717 N 18TH ST |
Practice Address - Street 2: | SUITE 1 |
Practice Address - City: | CENTERVILLE |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52544-1164 |
Practice Address - Country: | US |
Practice Address - Phone: | 641-856-2606 |
Practice Address - Fax: | 641-856-2616 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-11-06 |
Last Update Date: | 2007-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |