Provider Demographics
NPI:1770772535
Name:CORNERSTONE COUNSELING, P.C.
Entity type:Organization
Organization Name:CORNERSTONE COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:308-382-1764
Mailing Address - Street 1:3280 WOODRIDGE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7481
Mailing Address - Country:US
Mailing Address - Phone:308-382-1764
Mailing Address - Fax:308-395-3730
Practice Address - Street 1:3280 WOODRIDGE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7481
Practice Address - Country:US
Practice Address - Phone:308-382-1764
Practice Address - Fax:308-395-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078358200Medicaid
NE47078358200Medicaid