1073209904 NPI number — CORNERSTONE CHRISTIAN COUNSELING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073209904 NPI number — CORNERSTONE CHRISTIAN COUNSELING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE CHRISTIAN COUNSELING, INC.
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:
1073209904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3609 S WADSWORTH BLVD STE 132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80235-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-902-3068
Provider Business Mailing Address Fax Number:
303-484-3943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 PASEO REYES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32095-8464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-439-4400
Provider Business Practice Location Address Fax Number:
303-484-3943
Provider Enumeration Date:
04/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CO-FOUNDER, CEO
Authorized Official Telephone Number:
303-902-3068

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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