Healthcare Provider Details

I. General information

NPI: 1033281084
Provider Name (Legal Business Name): CORNERSTONE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 N MAIN ST
CENTERVILLE IA
52544-1432
US

IV. Provider business mailing address

526 N MAIN ST
CENTERVILLE IA
52544-1432
US

V. Phone/Fax

Practice location:
  • Phone: 641-856-2606
  • Fax:
Mailing address:
  • Phone: 641-856-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIA

VIII. Authorized Official

Name: ANGELA S. ELLISON
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: R.N.
Phone: 641-856-2606