=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154775005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNER STONE COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2016
-----------------------------------------------------
Last Update Date | 04/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2350 S JONES BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-610-2661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 HEALING WATERS LN
-----------------------------------------------------
City | N LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89031-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE LYNN TURNER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 702-610-2661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------