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General NPI Number Information
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NPI Number | 1649856360
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Entity Type | Organization
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Legal Business Name | CORNERSTONE FAMILY PSYCHIATRY PLLC
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 580 DECKER DR STE 260
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City | IRVING
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State | TX
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Zip | 75062-2306
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Country | US
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Telephone | 972-891-9117
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Fax | 888-272-1333
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Provider Business Mailing Address
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Address Line | 580 DECKER DR STE 260
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City | IRVING
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State | TX
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Zip | 75062-2306
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Country | US
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Telephone | 972-891-9117
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Fax | 888-272-1333
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | NICHOLAS GREGORY HEYNE
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Credential | MD
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Telephone | 972-891-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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