Provider Demographics
NPI:1982923314
Name:CORNERSTONE CLINICAL SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT CANDIDATE
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-284-8036
Mailing Address - Street 1:3821 NW BELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4960
Mailing Address - Country:US
Mailing Address - Phone:580-284-8036
Mailing Address - Fax:
Practice Address - Street 1:807 SW F AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4506
Practice Address - Country:US
Practice Address - Phone:580-595-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1201101Y00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty