1801067012 NPI number — CORNERSTONE COUNSELING & CONSULTING, P.C,

Table of content: (NPI 1801067012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801067012 NPI number — CORNERSTONE COUNSELING & CONSULTING, P.C,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE COUNSELING & CONSULTING, P.C,
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801067012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10315 DAWSONS CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46825-1912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-387-6340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10315 DAWSONS CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-387-6340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HECK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
260-387-6340

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  20041203A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X , with the licence number: 5386 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000175606 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 279625278002 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0007772138 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".