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General NPI Number Information
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NPI Number | 1952866790
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Entity Type | Organization
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Legal Business Name | CORNERSTONE OCD ANXIETY GROUP
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 9445 NE BUSINESS PARK LN STE 206
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-4634
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Country | US
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Telephone | 844-623-9675
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Fax | 888-977-1564
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Provider Business Mailing Address
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Address Line | 36 WOOD AMBER LN UNIT A
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City | PALM COAST
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State | FL
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Zip | 32164-7960
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Country | US
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Telephone | 844-623-9675
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Fax | 888-977-1564
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Authorized Official
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Title or Position | OWNER
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Name | MARY RENATTE HORN
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Credential | LMHC
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Telephone | 206-335-7429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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