Provider Demographics
NPI:1225200611
Name:CORNERSTONE COUNSELING OF BELLEVUE, LLC
Entity type:Organization
Organization Name:CORNERSTONE COUNSELING OF BELLEVUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:419-483-9411
Mailing Address - Street 1:817 KILBOURNE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9431
Mailing Address - Country:US
Mailing Address - Phone:419-483-9411
Mailing Address - Fax:419-483-9247
Practice Address - Street 1:817 KILBOURNE ST
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9431
Practice Address - Country:US
Practice Address - Phone:419-483-9411
Practice Address - Fax:419-483-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty