Healthcare Provider Details

I. General information

NPI: 1225200611
Provider Name (Legal Business Name): CORNERSTONE COUNSELING OF BELLEVUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 KILBOURNE ST SUITE G
BELLEVUE OH
44811-9431
US

IV. Provider business mailing address

817 KILBOURNE ST SUITE G
BELLEVUE OH
44811-9431
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-9411
  • Fax: 419-483-9247
Mailing address:
  • Phone: 419-483-9411
  • Fax: 419-483-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE3595
License Number StateOH

VIII. Authorized Official

Name: MR. DANIEL JOSEPH HIGGINS
Title or Position: OWNER
Credential: MA, LPCC
Phone: 419-483-9411