Healthcare Provider Details

I. General information

NPI: 1124139928
Provider Name (Legal Business Name): CORNERSTONE PSYCHOLOGICAL AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 STATE ROUTE 39 HUMMIL BLDG
BERLIN OH
44610
US

IV. Provider business mailing address

259 SANDUSKY ST
ASHLAND OH
44805
US

V. Phone/Fax

Practice location:
  • Phone: 330-893-8100
  • Fax: 330-893-7209
Mailing address:
  • Phone: 419-289-1876
  • Fax: 419-281-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JOHN C SHULTZ
Title or Position: PRESIDENT OWNER
Credential: PHD
Phone: 419-289-1876