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
StateLicense IDTaxonomies
IA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory