Healthcare Provider Details

I. General information

NPI: 1629956040
Provider Name (Legal Business Name): CORNERSTONE BEHAVIORAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 CREEKSIDE MEADOWS DR
LIBERTY TWP OH
45011-0754
US

IV. Provider business mailing address

5602 CREEKSIDE MEADOWS DR
LIBERTY TWP OH
45011-0754
US

V. Phone/Fax

Practice location:
  • Phone: 513-254-3893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FIDELIS SANGYE
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 513-254-3893