Healthcare Provider Details

I. General information

NPI: 1164725560
Provider Name (Legal Business Name): CORNERSTONE COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W HICKORY ST SUITE 213
DENTON TX
76201-4156
US

IV. Provider business mailing address

814 FAIRVIEW CIR
KRUGERVILLE TX
76227-2811
US

V. Phone/Fax

Practice location:
  • Phone: 940-367-8398
  • Fax:
Mailing address:
  • Phone: 940-367-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61305
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number200982
License Number StateTX

VIII. Authorized Official

Name: BRETT E HETRICK
Title or Position: OWNER
Credential: LPCS, LMFT, NCC
Phone: 940-367-8398