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General NPI Number Information
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NPI Number | 1922295203
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Entity Type | Organization
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Legal Business Name | CORNERSTONE ADVOCACY SERVICE
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 1000 EAST 80TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420
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Country | US
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Telephone | 952-884-0376
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Fax | 952-884-2135
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Provider Business Mailing Address
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Address Line | 1000 EAST 80TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420
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Country | US
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Telephone | 952-884-0376
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Fax | 952-884-2135
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | DAVID JAY MATHEWS
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Credential | PSYD, LICSW
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Telephone | 952-646-6507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 13053
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License Number State | MN
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