Healthcare Provider Details

I. General information

NPI: 1871791202
Provider Name (Legal Business Name): CORNERSTONE BRIEF THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 COUNCIL ST NE SUITE 120
CEDAR RAPIDS IA
52402-5878
US

IV. Provider business mailing address

5925 COUNCIL ST NE SUITE 120
CEDAR RAPIDS IA
52402-5878
US

V. Phone/Fax

Practice location:
  • Phone: 319-393-6796
  • Fax: 319-378-8621
Mailing address:
  • Phone: 319-393-6796
  • Fax: 319-378-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001032
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. KENDRA J BAILEY
Title or Position: THERAPIST
Credential: LMHC
Phone: 319-393-6796