Provider Demographics
NPI:1073367306
Name:CORNERSTONE YOUTH COLLECTIVE
Entity type:Organization
Organization Name:CORNERSTONE YOUTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & CO FOUNDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAYLIAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BECKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:AAC , CBT
Authorized Official - Phone:425-390-4062
Mailing Address - Street 1:720 SENECA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3265
Mailing Address - Country:US
Mailing Address - Phone:425-390-4062
Mailing Address - Fax:
Practice Address - Street 1:720 SENECA ST STE 107
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3265
Practice Address - Country:US
Practice Address - Phone:425-390-4062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366191223Medicaid