MEDICARE: CORNERSTONE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023770849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	4154 DOUGLASS LOOP
Second Line	:
City	:	USAF ACADEMY
State	:	CO
Zip	:	80840-1005
Country	:	US
Telephone Number	:	209-769-5610
Fax Number	:

Provider Business Practice Location Address
First Line	:	4291 AUSTIN BLUFFS PKWY STE 204
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2901
Country	:	US
Telephone Number	:	209-769-5610
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEIDI TUCKER
Credential	:
Telephone Number	:	209-769-5610

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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