Provider Demographics
NPI:1982614848
Name:CORNERSTONE BRIEF THERAPY, INC.
Entity Type:Organization
Organization Name:CORNERSTONE BRIEF THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:319-393-6796
Mailing Address - Street 1:5925 COUNCIL ST NE
Mailing Address - Street 2:120
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5878
Mailing Address - Country:US
Mailing Address - Phone:319-393-6796
Mailing Address - Fax:319-378-8621
Practice Address - Street 1:5925 COUNCIL ST NE
Practice Address - Street 2:120
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5878
Practice Address - Country:US
Practice Address - Phone:319-393-6796
Practice Address - Fax:319-378-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00807103T00000X
IA00337103TH0100X
IA00129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23629OtherWELLMARK
IA23629OtherWELLMARK