=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487003190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE COUNSELING SERVICES OF ARIZONA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2016
-----------------------------------------------------
Last Update Date | 01/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3611 CROSSINGS DR STE A
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86305-7181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-232-0168
-----------------------------------------------------
Fax | 928-232-0168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3755 E BROADWAY RD APT 56
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85206-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SCOTT KERR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-386-2562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LCSW-13864
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------