Healthcare Provider Details

I. General information

NPI: 1699308080
Provider Name (Legal Business Name): CORNERSTONE CARE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6702 KEATON CORPORATE PKWY STE 103
O FALLON MO
63368-8630
US

IV. Provider business mailing address

6702 KEATON CORPORATE PKWY STE 103
O FALLON MO
63368-8630
US

V. Phone/Fax

Practice location:
  • Phone: 314-283-5599
  • Fax:
Mailing address:
  • Phone: 314-283-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN M WORZEL
Title or Position: OWNER
Credential: LCSW
Phone: 314-283-5599