Healthcare Provider Details

I. General information

NPI: 1609970763
Provider Name (Legal Business Name): CORNERSTONE COUNSELING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 A PROFESSIONAL PARK DRIVE
MARYVILLE IL
62062
US

IV. Provider business mailing address

20 A PROFESSIONAL PARK DRIVE
MARYVILLE IL
62062
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-8787
  • Fax: 618-288-0737
Mailing address:
  • Phone: 618-288-8787
  • Fax: 618-288-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. TIFFANY LEIGH MARSH
Title or Position: OWNER/MENTAL HEALTH THERAPIST
Credential: MA. LCPC, LPC, NCC
Phone: 618-288-8787