Healthcare Provider Details

I. General information

NPI: 1952866790
Provider Name (Legal Business Name): CORNERSTONE OCD ANXIETY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 NE BUSINESS PARK LN STE 206
BAINBRIDGE ISLAND WA
98110-4634
US

IV. Provider business mailing address

1809 GREEN PL
ORMOND BEACH FL
32174-7218
US

V. Phone/Fax

Practice location:
  • Phone: 844-623-9675
  • Fax: 888-977-1564
Mailing address:
  • Phone: 844-623-9675
  • Fax: 888-977-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MARY RENATTE HORN
Title or Position: OWNER
Credential: LMHC
Phone: 206-335-7429