Healthcare Provider Details

I. General information

NPI: 1649366865
Provider Name (Legal Business Name): CORNERSTONE FOUNDATIONS FOR FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N 9TH ST
QUINCY IL
62301-2742
US

IV. Provider business mailing address

316 N 9TH ST
QUINCY IL
62301-2742
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-8254
  • Fax: 217-222-4512
Mailing address:
  • Phone: 217-222-8254
  • Fax: 217-222-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MCKELVIE
Title or Position: DIRECTOR
Credential:
Phone: 217-222-8254