Healthcare Provider Details

I. General information

NPI: 1851938500
Provider Name (Legal Business Name): CORNERSTONE PSYCHOTHERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54240 RIDGEVIEW DR.
IDYLLWILD CA
92549
US

IV. Provider business mailing address

P.O. BOX 3519
IDYLLWILD CA
92549
US

V. Phone/Fax

Practice location:
  • Phone: 760-207-7486
  • Fax:
Mailing address:
  • Phone: 760-207-7486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARA WILKERSON
Title or Position: OWNER/CLINICAL SUPERVISOR
Credential: LMFT
Phone: 760-207-7486