=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851620645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE COUNSELING SERVICES,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2009
-----------------------------------------------------
Last Update Date | 12/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E 4TH ST SUITE A
-----------------------------------------------------
City | TOMPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42167-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-407-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 E 4TH ST SUITE A
-----------------------------------------------------
City | TOMPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42167-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-407-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. GREGORY STEVEN TURNER
-----------------------------------------------------
Credential | M.ED.
-----------------------------------------------------
Telephone | 270-407-5454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1006
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------