MEDICARE: CORNERSTONE RECOVERY INC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	2455A	TX

General Provider Information

NPI Number	:	1811028483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE RECOVERY INC

Provider Business Mailing Address
First Line	:	PO BOX 130938
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77219-0938
Country	:	US
Telephone Number	:	713-528-6720
Fax Number	:	713-520-6720

Provider Business Practice Location Address
First Line	:	6699 PORTWEST DRIVE
Second Line	:	SUITE 140
City	:	HOUSTON
State	:	TX
Zip	:	77024-8002
Country	:	US
Telephone Number	:	713-528-6720
Fax Number	:	713-520-6720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANETTE TEMPLE EDENS
Credential	:	PHD
Telephone Number	:	713-528-6720

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	03/27/2012

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Directions to “CORNERSTONE RECOVERY INC ” Practice Location

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