Healthcare Provider Details

I. General information

NPI: 1922353119
Provider Name (Legal Business Name): CORNERSTONE COUNSELING SERVICE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E JACKSON ST
HUGO OK
74743
US

IV. Provider business mailing address

PO BOX 61
HUGO OK
74743-0061
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-2200
  • Fax: 580-326-2201
Mailing address:
  • Phone: 580-326-2200
  • Fax: 580-326-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN E FOSTER
Title or Position: OWNER
Credential: B.H.R.S.
Phone: 580-326-2200