Healthcare Provider Details

I. General information

NPI: 1508090911
Provider Name (Legal Business Name): CORNERSTONE CHRISTIAN COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST SUITE 110
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

1090 N 10TH ST SUITE 110
KALAMAZOO MI
49009-5733
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax: 269-375-4363
Mailing address:
  • Phone: 269-375-4363
  • Fax: 269-375-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401005766
License Number StateMI

VIII. Authorized Official

Name: MR. BARRY JON BRIGHAM
Title or Position: PRESIDENT
Credential: MA, LLP, LPC
Phone: 269-569-5535