Healthcare Provider Details

I. General information

NPI: 1104113729
Provider Name (Legal Business Name): CORNERSTONES COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2011
Last Update Date: 07/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18402 103RD AVE NE
BOTHELL WA
98011-3410
US

IV. Provider business mailing address

18402 103RD AVE NE
BOTHELL WA
98011-3410
US

V. Phone/Fax

Practice location:
  • Phone: 425-415-6556
  • Fax: 425-488-0269
Mailing address:
  • Phone: 425-415-6556
  • Fax: 425-488-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLH00007108
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. REBECCA KIRCHNER
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 425-415-6556